ACCESS Member Services Specialist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Conduct telephonic screenings and gather demographic details.

• Verify and confirm the eligibility of members and recipients.

• Provide provider options based on consumer inquiries and service requirements.

• Arrange appointments adhering to established access time standards.

• Connect members with contracted providers for clinical evaluations.

• Recognize risk indicators and promptly refer to Member and Recipient Services Clinicians.

• Manage customer service calls related to enrollment, services, referrals, provider modifications, Social Determinants of Health needs, and general inquiries.

• Share information about Vaya Partners, its provider network, community resources, and North Carolina Medicaid services.

• Execute warm transfers and connect callers to the relevant parties, providers, vendors, community organizations, and legal guardians.

• Record call notes, forms, reports, and other necessary information in electronic systems.

• Report service-system gaps and needs to managers or Provider Network Development personnel.

• Administer Customer Satisfaction Surveys and comply with the NCMT Call Grading Rubric.

• Support specialized ACCESS Call Center projects and undertake other assigned responsibilities.

⛳️ Requirements

• A Bachelor’s degree in a Human Services field with a minimum of two years of experience working with adults or children who have serious psychiatric, chemical dependence, or developmental disabilities in a community mental health center or similar environment, OR a Bachelor’s degree from an accredited institution with at least four years of such experience.

• Must meet the qualifications of a Qualified Professional as per 10A NCAC 27G .0104.

• Experience in delivering mental health, substance abuse services, or services for intellectual/developmental disabilities.

• Understanding of social work principles, techniques, and practices.

• Familiarity with behavioral health principles and intricate treatment and service delivery.

• Knowledge of person-centered and recovery-oriented philosophies.

• Awareness of mental health, developmental disabilities, and substance abuse disorders.

• Understanding of North Carolina’s Medicaid system.

• Familiarity with the laws, regulations, and policies governing human services and utilization management.

• Proficiency in using complex telephone and computer systems, and multiple technology platforms concurrently during live calls.

• Ability to document information electronically and complete required documentation during the call.

• Excellent oral and written communication skills.

• Capacity to interact professionally with individuals who may be upset or disagree.

• Must reside in North Carolina or within 40 miles of the North Carolina border.

🏝️ Benefits

• Eligibility for overtime compensation.

• Comprehensive training in customer service skills, insurance plans, applicable confidentiality laws, and related systems.

• Equal opportunity employer.