Behavioral Health Access & Referral Specialist

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 36,000 - 54,000; Full time

Job summary

CommunityCare HMO Inc. in Tulsa, OK is seeking a Customer Service Representative to support behavioral health benefits, guide members to in-network services, and process prior authorizations in line with CMS and State regulations.

You will handle provider letters, member communications, and resolve behavioral health related situations from calls. Ideal candidates will have strong communication, confidentiality, and multitasking abilities, with experience in healthcare or customer service and

Qualifications

• Basic punctuation and grammar skills.
• Ability to multi-task and manage time efficiently.
• Proficient in Microsoft applications.
• Strong oral communication skills.
• Successful completion of Health Care Sanctions background check.

Responsibilities

• Available and able to be telephone support from 8AM -5PM except for lunch and breaks to support behavioral health needs for all lines of business.
• Provides resolution for various types of phone calls including, but not limited to referral, authorization, and verifying member eligibility, line of business and network affiliations for members and providers.
• Determines if the call is clinical and requires transfer to a clinical staff person. Will inform callers, including members, facility personnel, physicians, or other health care professionals of the utilization requirements and procedures.
• Makes initial referrals that do not require evaluation or interpretation of clinical information to behavioral health services. Completes appropriate electronic certification and progress notes documentation of activities as needed.
• Assists with specialized job tasks which may include claims corrections and follow-up with provider/member questions regarding claims payments, generate provider faxes, generate member letters, and other administrative tasks.
• Work may also involve dealing with members who are disgruntled or upset.
• Performs other duties as required.

Skills

Multitasking

Time management

Oral communication

Microsoft Office

Confidentiality

Telephone support

Independent work

Education

High school diploma or equivalent

Job description

CommunityCare HMO Inc. in Tulsa, OK is seeking a Customer Service Representative to support behavioral health benefits, guide members to in-network services, and process prior authorizations in line with CMS and State regulations.

You will handle provider letters, member communications, and resolve behavioral health related situations from calls. Ideal candidates will have strong communication, confidentiality, and multitasking abilities, with experience in healthcare or customer service and