Immediate need for a talented Intake Care Senior Representative Medical Management. This is a 05+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:24-47328 Pay Range: $20 - $21/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities:
- Educating customers on benefits, eligibility, referrals, non-clinical resources and assessing for potential risk of harm or substance abuse concerns.
- This position services calls in a warm and empathetic manner as many of the calls are sensitive in nature.
- Independent problem-solving skills are critical to success within the role along with intelligent judgment of assessing the callers needs.
- Based upon the call type and requests advocates should be able to use customer service skills, knowledge of the mental health/substance abuse field and Client training to effectively address callers needs in an educational manner.
- Incumbents will utilize telephonic communication most of the time with some web, and internal CBH materials to achieve first time resolution for callers.
- Answering calls from customers including providers. Most of the day will be answering inbound calls from customers looking to access, understand, or utilize services.
- Register participants in the intake system and opens case files.
- Educate participants on their benefits based upon individual plan design and other clinical or non-clinical resources available.
- Conduct an intake as needed to assess for presenting concern and risk of harm or substance abuse concerns.
- Provide participants with names and phone numbers of nearest providers.
- Multi-task by maneuvering through various computer programs and screens.
- Write authorizations to ensure claims are paid correctly.
- Provide follow-up calls to participants to ensure correct information is given.
- Send eligibility requests to determine effective coverage dates or to verify correct benefits are loaded.
- Send complaints to initiate grievance process for customers.
- On all calls an advocate is responsible for:
- Providing high quality customer service as identified by Advocacy department quality standards.
- Using independent problem-solving skills to make sound decisions in assessing the needs of the callers by giving accurate information and providing first call resolution.
- Understanding the business needs of the role, while balancing the needs of the customer.
- Taking an educational approach to ensure callers can understand the complexities of accessing care.
- Demonstrating a complete awareness and understanding of the responsibilities and workflows of the various departments within Client.
- Delivers specific delegated Utilization Management tasks assigned by a supervisor.
- Assigns client to appropriate staff member or behavioral health network provider for assessment and counseling.
- Serves as initial contact for clients and their eligible dependents requesting services.
- Responsible for customer service and relevant standards such as telephone response time.
- May make referrals within stated limits.
- Supports and assists with training for employees.
- May provide guidance around procedures and workflows.
- Completes day-to-day Intake Care tasks without immediate supervision, but has ready access to advice from more experienced team members.
- Tasks involve a degree of forward planning and anticipation of needs/issues.
- Resolves non-routine issues escalated from more junior team members
Key Requirements and Technology Experience:
- Key Skills:Behavioral Health
- Customer Service
- Bachelors in psychology, Social Work etc
- Previous customer service experience or related position.
- Superb interpersonal communication.
- Effective listening and organizational skills.
- Ability to manage multiple tasks, setting priorities where needed.
- Independently problem solve, with ability to function without constant supervision.
- A demonstrated ability to type effectively; with strong PC skills/word processing experience and ability to learn new computer software systems.
- Ability to learn new workflows and tasks quickly.
- Ability to work independently and be a team player.
- Previous call center environment experience preferred.
- Computer multi-tasking - working in numerous screens while staying engaged with customer.
- Bachelor's degree in mental health field or psychology/social work-related field required.
Our client is a leading Healthcare and insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .#prof