ACCESS Provider Services Specialist

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

📋 Description

• Support network providers with inquiries concerning claims, contracts, authorizations, benefits, services, registries, and community resources.

• Manage incoming phone calls, aiming for resolution on the first contact.

• Make outbound calls based on designated work queues, lists, and tasks.

• Record all call interactions and routing activities following established workflows and procedures.

• Provide information and address providers’ inquiries, concerns, and questions via phone.

• Conduct initial assessments of callers’ needs and determine the appropriate method for handling calls.

• Educate providers on the resources available through Provider Central.

• Offer navigation assistance for forms, training materials, and contracting information.

• Verify provider identities, assess needs, and connect callers to the suitable One Touch workgroup.

• Act as a liaison between departments concerning inquiries, processes, and information resources.

• Update materials related to call center operations as assigned.

• Serve as a subject matter expert regarding Provider Support Line call center functions.

• Complete progress notes, forms, reports, and other necessary documentation during the call and by the end of the workday or shift.

• Assist with specialized ACCESS Call Center projects and reviews as requested by management.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor’s degree in a Human Services field with a minimum of two years of experience working with adults or children facing serious psychiatric, substance 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 equivalent experience.

• Must qualify as a Qualified Professional as per 10A NCAC 27G .0104.

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

• Extensive knowledge of the MH/SU/DD service offerings provided through the Vaya Partners network.

• Familiarity with Medicaid 1115, Medicaid B and C waivers, and Vaya Partners accreditation standards.

• Understanding of BH I/DD Tailored Plan eligibility, services, policies, procedures, and Provider Manual guidelines.

• Ability to manage confidential healthcare information and protected health information (PHI), adhere to HIPAA and related confidentiality regulations, complete mandatory confidentiality training, and sign a confidentiality agreement.

• High degree of diplomacy and discretion.

• Outstanding interpersonal and communication abilities.

• Quick independent decision-making, problem solving, negotiation, arbitration, and conflict resolution skills.

• Capability to prioritize and manage multiple tasks and projects from inception to completion.

• Ability to adapt to evolving priorities.

• Close visual acuity and the capacity to perform sedentary work, sit for extended periods, and lift up to 10 pounds.

• Preferred: Over 2 years of experience in a network management role dealing with complex network providers in the healthcare sector.

🏝️ Benefits

• Monday to Friday work schedule, from 9:30 am to 6:00 pm.

• 40-hour work week.

• Eligibility for overtime compensation.

• Remote, home-based virtual position.

• Holiday rotation as required by the business.