Member Services Provider Support Line Rep.

LOCATION: Position is remote, however incumbent is required to reside in North Carolina.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

GENERAL STATEMENT OF JOB:

This shift for this position is Monday-Friday 8:30 am - 5:00 pm, however shift is subject to change. The Member and Recipient Services Provider Support Line Representative (MRSPSLR) is responsible for assisting providers with inquiries related to claims, contracts, authorizations, benefits, services, registries, and community resources. MRSPSLR provide appropriate screening, handling and routing of incoming phone calls with the goal to provide first call resolution when possible. MRSPSLR are trained in specific functional areas for provider services and are also trained to handle overall inquiries and provide high quality customer service. The role may also initiate outbound calls per established work queues, lists and assignments. The MRSPSLR is responsible for documentation of all calls and routing activities for follow up through defined workflows and processes.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONS:

Handle telephonic requests for assistance from network providers or potential network providers:

• Interacts by phone with providers to provide information in response to inquiries, concerns, and questions
• Performs initial triage of callers needs to determine appropriate handling of the call
• Complete referrals to other teams such as Care Management when appropriate
• Interact with providers to provide information in response to inquiries about services and other resources
• Perform research on billing inquires and claims to inform providers including educating on processes for resolving identified issues
• Research payment and refund issues and provide follow up as appropriate
• Liaison between various departments to address questions and provide basic information about Vaya Health, including processes and where to find information
• Identify, research, resolve and follow-up on provider inquiries not immediately resolved.
• Complete referrals to other teams for follow up on issues, concerns, or member/recipient needs
• Interacts with providers to provide information in response to inquiries about services and other resources.
• May be assigned responsibility for updating materials related to call center operation
• Serves as a subject matter expert for call center operations for Provider Network

Documentation in the electronic information system:

The MRSPSLR will complete progress notes, forms, reports and other documentation as required. The MRSPSLR will complete required documentation at the time of call. All documentation must be complete at the end of the workday or shift.

Tracking and referral:

The MRSPSLR will track providers needs to ensure that appropriate follow up has been completed within Vaya and refer to other departments as appropriate.

Specialized projects and reviews:

The MRSPSLR will assist in specialized Member and Recipient Services Departmental projects as requested by the Member and Recipient Services Directors, and/or Vice President of Member and Recipient Services.

Other duties as assigned

QUALIFICATIONS & EDUCATION REQUIREMENTS:

A Bachelor's degree in Human Services (such as Psychology, Social Work, etc.) is required with two years of post-degree progressive experience providing similar services to the population served.

Preference will be given to applicants with 2+ years of experience in a network management-related role handling complex network providers in the health care industry.

PHYSICAL REQUIREMENTS:

This position must have the ability to establish appropriate and respectful relationships/partnerships with organizational personnel. Ability to work with a multidisciplinary team approach. Ability to assume a helping role and to intervene appropriately to meet the needs of providers, consumers or families served. Works within the established ethical guidelines developed for the profession.

KNOWLEDGE, SKILL & ABILITIES:

A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts. Problem solving, negotiation, arbitration and conflict resolution skills are essential to balance the needs of both internal and external customers. Must be highly skilled at shifting between macro and micro level planning, maintaining both the big picture and seeing that the details are covered.

MRSPSLR must have considerable knowledge of the MH/SU/DD service array provided through the network of Vaya providers. Additional knowledge in Medicaid 1115, Medicaid B and C waivers and Vaya's accreditation requirements is essential.

The employee must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish. Work activities quickly change according to mandated changes and changing priorities within the department. The employee must be able to change the focus of his/her activities to meet changing priorities.

Training, learning and proficiency are tracked through the MRSPSL Training Matrix and any other required means. Training may be delivered in a variety of methods and forums. MRSPSL Manager must understand the following areas, in addition to other required trainings:

* BH I/DD Tailored Plan eligibility and services

* Trained on the requirements, policies and procedures of the BH I/DD Tailored Plan operating in North Carolina and are able to respond to all areas within the Provider Manual, including resolving claims payment inquires in one touch.

Considerable knowledge of governmental and private organizations and resources in the community is beneficial. Considerable knowledge of the laws, regulations, and policies which govern the Service Management programs is beneficial. General knowledge of the methods and principles of recovery and person-centered thinking is needed. Team building and supervisory skills are essential. Skill in establishing rapport with staff/consumers in discussing their issues is necessary. The abilities to supervise, train, or instruct lower-level staff. An ability to establish and maintain effective working relationships with civic, legal, medical, social, provider, advocacy, and religious organizations within Vaya's 31 counties are required. The Member and Recipient Services Manager must have the ability to express ideas clearly and concisely and to plan and execute work effectively. Computer skills and abilities to learn and master a variety of information technology systems including:

complex phone systems,

Microsoft Office programs,

Visio,

NCTRACKS,

Bright metrics,

and other Vaya information systems are required.

LOCATION REQUIREMENT:

In accordance with the BH and I/DD Tailored Plan requirements mandated by the NC Department of Health and Human Services, certain Vaya Health positions are required to be filled by individuals who reside in North Carolina, meaning someone who establishes a legal domicile in North Carolina and pays income tax in North Carolina, or resides within 40 miles of the North Carolina border. New hires from outside of North Carolina will have 60 days from the date of hire to meet this requirement, if applicable to the position.

This position is required to reside in North Carolina or within 40 miles of the North Carolina Boarder.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit http://www.vayahealth.com/careers-overview/ Ind.001