New Directions Behavioral Health Benefit and Referral Specialist I in NONE, Missouri

ESSENTIAL FUNCTIONS:

• Receive initial calls from providers, clients, and members, routing appropriate calls to their respective departments.

• Verify demographic information, and providing benefits, claims, and basic billing/coding information in accordance with HIPPA law. Essential that each Specialist be able to handle information such as where to send claims, how to identify appropriate benefits, describe product information to providers and members, assist other departments in attempting to solve more basic issues before transferring calls.

• Triage crisis callers to clinical staff for appropriate assistance. Assessing levels of risk beyond the customer service scope.

• Assist with status checks of authorizations for additional services, and basic appeals inquiries.

• Provide routine referrals to callers to network providers.

• Provide relevant paperwork for providers to adjust demographic information in the system, and to obtain authorization for further treatment for their patients.

• Meet internal standards set forth to comply with company contract requirements.

• Assist coworkers in training new hires on procedural aspects of position, including documentation, orientation within the organization, and compliance rules and regulations.

• Cross train on additional books of business as required by team.

• Able to work simultaneously between multiple systems to provider member/provider mental health benefits.

• Telephonically respond to and resolve routine claims status questions and provide information related to denials or claims submission. Triage to the appropriate staff, department or third party administrator when not routine.

• Simultaneously communicate telephonically and type.

• Adhere to department goals and guidelines.

• Consistently meets individual goals for attendance, ready time, incoming calls, documentation and quality.

• Demonstrates use of MAGIC customer service concepts in all communication.

• Willingness to work a variety of shifts if necessary.

• Cross trained in different lines of business.

• Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct, and Compliance Program.

• Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding privacy, confidentiality, and security of health information, and other designated information.

EDUCATION & EXPERIENCE REQUIRED/PREFERRED:

• High School diploma plus five years of customer service experience, or Associates degree and three years of experience or Bachelor’s degree; Bachelor’s degree in a social science or health related field preferred

• Able to concurrently communicate telephonically and type; Call Center experience preferred

• Proven written and oral communication skills, organizational skills, demonstrated willingness to work within a collaborative, team-oriented environment.

• Two plus years medical billing/coding and/or claims experience (mental health preferred)

• Working knowledge of health insurance as a whole

• Spanish fluency preferred but not required

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.

Qualifications