ACCESS Provider Services Specialist Remote NC)

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Full Time Hourly Professional Remote, Remote, NC, US

5 days ago Requisition

Salary Range: $42,000.00 To $65,000.00 Annually

LOCATION: Remote – this is a home based, virtual position. The person in this position must maintain residency in North Carolina or within 40 miles of the NC border.

Work Schedule: Monday – Friday from 9:30 am – 6:00 pm. This is a 40 hour per week position.

GENERAL STATEMENT OF JOB

The ACCESS Provider Services Specialist is responsible for assisting providers with inquiries related to claims, contracts, authorizations, benefits, services, registries, and community resources. ACCESS Provider Services Specialist provides appropriate screening, handling and routing of incoming phone calls with the goal to provide first call resolution when possible. ACCESS Provider Services Specialists 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 ACCESS Provider Services Specialist is responsible for documentation of all calls and routing activities for follow up through defined workflows and processes. This job is subject to working holidays and holiday rotation as deemed necessary by the business.

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 Partners.

The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Partners.

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
• Interact with providers to provide information in response to inquiries about services and other resources
• Educates providers on resources available to providers on Provider Central
• Provides navigational support to frequently used forms, training guides, and information related to contracting with Vaya Partners
• Authenticate providers, identify needs and connect callers to the appropriate One Touch workgroup for assistance. This includes, but is not limited to, inquiries related to claims, billing, authorizations, contracting, and credentialing.
• Liaison between various departments to address questions and provide basic information about Vaya Partners, including processes and where to find information
• May be assigned responsibility for updating materials related to call center operation
• Serves as a subject matter expert for Provider Support Line call center operations

Documentation in the electronic information system:

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

Specialized projects and reviews:

The…