PartnersACCESS Call Center Representative (Remote-NC)

Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Remote option; Available for any of Partners' NC locations Closing Date: Open Until Filled Primary Purpose of Position: This position provides nonclinical administrative support to the PartnersACCESS call center. The Call Center Representative primary responsibility is to answer inbound calls and assist callers by connecting them to the appropriate party, sharing information, providing technical assistance, answering questions, handling and/or resolving complaints. Must maintain a high level of professionalism, patience and empathy working with callers who may be frustrated and may have complex medical, behavioral health, intellectual and other developmental conditions; and must still maintain the highest level of customer satisfaction by seeking first call resolution. Must live in North Carolina and preferably in Partners counties. Role and Responsibilities: Ability to learn complex information about two Medicaid health plans and their benefits. Work in a call center environment and interact with callers who are generally members and providers, to deliver information, answer frequently asked questions, and address complaints. Route calls to the appropriate resource. Including appropriately identifying and elevating those more complex or crisis calls. Understand Health/Mental Health (MH)/Substance Use (SU)/Traumatic Brain Injury (TBI)/Intellectual/Developmental Disability (I/DD) treatment needs, benefit information and referral of members calling to determine if they may potentially qualify for services. Review call notes, enrollments, registrations, or other identified documents for completeness and/or accuracy. Collect and enter demographic data into the electronic record, completion of appropriate forms, explanation of services, benefits and resources, verifies Medicaid and dispatch. Provide follow up calls. This position demands a high level of accuracy and confidentiality. Information must be handled according to NC standards and rules, state and federal laws and LME/MCO and NCQA standards, procedures, policies and protocol. Trained on the requirements, policies and procedures of the BH I/DD Tailored Plan operating in North Carolina and can respond to all areas within the Member Handbook and Provider Manual, including resolving claims payment inquires in one touch. Automation: Screenings are completed using standard and specialized computer programs. Inputs accurate information into the system and unlocks electronic service records with appropriate consents, enters all necessary data elements into data systems. Cooperative Efforts: Must be a team player and have a positive attitude. Establish and maintain effective working relationships within the unit, agency, and service system Consistently demonstrate professionalism, tact and diplomacy in handling volatile callers and/or working with contract providers and other external parties. Participate in Unit Staff meeting, Agency Staff meetings, (All staff meetings) and assigned committees. Interacts by phone with providers to provide information in response to inquiries, concerns, and questions. Interact with providers to provide information in response to inquiries about services and other resources. BH I/DD Tailored Plan eligibility and services. Knowledge, Skills and Abilities: Knowledge/Ability to Learn: Health, mental health, substance use, traumatic brain injury and intellectual/developmental disability service delivery and NC Medicaid Managed Care system as well as the resources available in the community. Call center functions, member population, potential for crisis issues, confidentiality laws and program protocols/policies. High level computer skills. Ability communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task. Ability to provide technical assistance to both members and Providers. Ability to maintain confidentiality when screening and referring calls. Education/Experience Required: High School diploma and at least (1) year of healthcare and/or MH/SU/IDD/TBI experience. Education/Experience Preferred: Associate degree or higher and one (1) year of healthcare or MH/SU/IDD/TBI experience, or Associates Degree in Nursing (ADNs) and at least one (1) year of healthcare and/or MH/SU/IDD/TBI experience. Bilingual preferred (for one of the positions). Licensure/Certification Requirements: N/A