Behavioral Health Champion
About The Position
The Behavioral Health Champion screens members for behavioral health treatment needs and helps them obtain appropriate care. The role applies knowledge of behavioral health conditions and treatment resources to connect members with suitable providers, follows up to ensure services meet their needs, and helps address barriers and social determinants of health. The position also facilitates care coordination and clinical consultation as needed. The Behavioral Health Champion maintains regular communication with in-network providers, tracks appointment availability, verifies provider information, and keeps Moda systems current and accurate. The role provides customer service to members and providers, documents contacts, supports access and reimbursement issue resolution, and identifies process and workflow improvements. This is a full-time work-from-home role. The position requires work beyond the standard workweek, including evenings and occasional weekends, as business needs require.
Requirements
- College degree or equivalent experience in a behavioral health setting.
- Typing speed of 35 words per minute.
- Computer proficiency and experience with Microsoft Office applications.
- Strong analytical, problem-solving, and organizational skills.
- Attention to detail and good memory retention.
- Strong verbal, written, and interpersonal communication skills.
- Ability to remain calm and provide excellent telephone customer service to providers and members.
- Ability to work under pressure with frequent interruptions and shifting priorities.
- Ability to work independently and as part of a team, interacting professionally with staff at all levels, members, and providers.
- Ability to arrive at work on time daily.
- Ability to maintain confidentiality and protect member information.
- Reliable, high-speed, hard-wired internet connection to support remote or hybrid work.
- Comfort with being on camera for virtual training and meetings.
Responsibilities
- Promptly answer member calls related to behavioral health treatment and provide professional telephone customer service.
- Administer a structured screening and decision-support tool to help members identify appropriate behavioral health treatment and support resources.
- Match member needs to suitable providers based on knowledge of behavioral health conditions and treatment resources.
- Schedule initial appointments for members or identify appropriate providers with availability.
- Follow up after members’ initial appointments to confirm a positive experience or help identify alternatives.
- Follow up with members after four to six weeks of care to confirm services are meeting their needs.
- Facilitate clinical consultation with a behavioral health case manager or care coordinator when needed to address barriers to treatment progress.
- Coordinate care with members’ primary care providers.
- Identify social determinants of health concerns and help members connect with appropriate resources.
- Cultivate and maintain working relationships with providers; communicate with contracted providers and track their availability for new patients.
- Provide customer service to providers to resolve claims, credentialing, and contracting issues.
- Verify provider demographics, availability, and clinical expertise, and ensure provider data in Moda systems is current and accurate.
- Update CaseTrakker Dynamo and send information to provider configuration for Facets as needed.
- Assist the Behavioral Health Clinical Liaison in identifying providers amenable to value-based contracting.
- Maintain communication and coordination with Behavioral Health and Care 360 teams.
- Identify, assess, and recommend process and workflow improvements within Behavioral Health and Care 360 teams.
- Coordinate with Contracting and Provider Relations regarding behavioral health provider contracting issues.
- Complete benefit exceptions and single case agreements using approved processes, as appropriate.
- Help members and providers resolve access or reimbursement issues related to behavioral health services.
- Document member and provider contacts thoroughly in Facets and Dynamo.
- Exercise judgment, initiative, and discretion in confidential and sensitive matters, and maintain client confidentiality.
- Perform other duties as assigned.
Benefits
- Medical, dental, vision, pharmacy, life, and disability coverage
- 401(k) matching
- Flexible spending account
- Employee Assistance Program
- Paid time off
- Company-paid holidays
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What This Job Offers
Job Type
Full-time
