Behavioral Health Champion

Moda Health; Portland (OR); Remote; USD 29,000 - 32,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Pharmacy,Life

401K- Matching

FSA

Employee Assistance Program

PTO and Holidays

Job summary

Moda Health is seeking a Behavioral Health Support Specialist for a full-time, work-from-home role in the Portland area. You will screen members for BH treatment needs, coordinate care with providers, and schedule initial appointments while addressing barriers related to social determinants of health.

The role emphasizes high-quality customer service, confidentiality, and collaboration across BH, Care 360, Claims, and IT teams.

Qualifications

• College degree or equivalent experience in behavioral health setting.
• Typing skills of 35 wpm.
• Computer proficiency with Microsoft Office applications.
• Strong analytical, problem solving, and organization skills.
• Strong verbal, written and interpersonal communication skills.
• Ability to provide telephone customer service to providers and members.
• Ability to work well under pressure with frequent interruptions and shifting priorities.
• Ability to work independently, as well as part of a team, dealing with all levels of staff, members, and providers.
• Ability to come in to work on time and daily.
• Ability to maintain confidentiality and protect the privacy of member information.

Responsibilities

• Promptly answers member calls related to behavioral health treatment.
• Provides telephonic customer service in a professional manner.
• Administers a structured screening and decision support tool to help members identify most appropriate BH treatment and support resources.
• Applies knowledge of behavioral health conditions and treatment resources to match member need to best fit providers.
• Directly schedules initial appointments for members seeking care or identifies appropriate providers with availability to see members.
• Follows up with members after initial appointment to confirm member’s positive experience or help member identify alternatives.
• Follows up with members after 4-6 weeks of care to confirm services are meeting member’s needs.
• Facilitates clinical consultation with BH case manager/care coordinator as needed to address barriers to treatment progress.
• Facilitates coordination of care with member’s primary care provider.
• Identifies concerns related to social determinants of health and assists members in connecting with appropriate resources.
• Cultivates and maintains good working relationships with providers.
• Communicates regularly with contracted providers and keeps apprised of providers’ availability to see new patients.
• Provides exceptional customer service to providers to resolve issues with claims, credentialing, contracting.
• Verifies providers’ demographics, availability and clinical expertise and ensures data in Moda systems including CaseTrakker Dynamo and Facets are up to date and accurate.
• Updates data in CaseTrakker Dynamo and sends information to provider configuration for Facets as needed.
• Assists BH Clinical Liaison in identifying providers amenable to value-based contracting.
• Maintains close communication and coordination with members of Behavioral Health and Care 360 teams.
• Identifies, assesses, and recommends opportunities for process and workflow improvements within Behavioral Health and Care 360 teams.
• Coordinates with Contracting and Provider Relations teams regarding contracting issues for behavioral health providers.
• Completes benefit exceptions and single case agreements as appropriate using approved processes.
• Assists members and providers in resolving issues related to access or reimbursement for BH services.
• Documents member and provider contacts with thorough notes in Facets and Dynamo.
• Exercises judgment, initiative, and discretion in confidential and sensitive matters.
• Maintains and always assures client confidentiality.

Skills

Typing 35 wpm

MS Office

Analytical skills

Communication skills

Customer service

Work under pressure

Team player

Punctuality

Confidentiality

Education

College degree in behavioral health

Tools

Microsoft Office

Job description

About Moda

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Let’s do great things, together!

About Moda

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.

Position Summary

Screens members for behavioral health (BH) treatment needs and assists members in obtaining appropriate behavioral health treatment. Applies knowledge of behavioral health conditions and treatment resources to match member need to best fit providers. Follows up with members to ensure behavioral health services are meeting the member’s needs. Identifies and assists with barriers and opportunities related to social determinants of health. Facilitates coordination of care and clinical consultation as needed. Communicates regularly with in-network providers, remains apprised of appointment availability, and ensures provider data is current and accurate in Moda systems.

This is a FT WFH role.

Pay Range

$21.30 - $23.96 hourly (depending on experience)

Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Required Skills, Experience & Education

• College degree or equivalent experience in behavioral health setting.
• Typing skills of 35 wpm.
• Computer proficiency and experience with Microsoft Office applications.
• Strong analytical, problem solving, and organization skills. Detail oriented with 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 well under pressure with frequent interruptions and shifting priorities.
• Ability to work independently, as well as part of a team, dealing with all levels of staff, members, and providers in a professional manner.
• Ability to come in to work on time and daily.
• Ability to maintain confidentiality and protect the privacy of member information.

Primary Functions

• Promptly answers member calls related to behavioral health treatment.
• Provides telephonic customer service in a professional manner.
• Administers a structured screening and decision support tool to help members identify most appropriate BH treatment and support resources.
• Applies knowledge of behavioral health conditions and treatment resources to match member need to best fit providers.
• Directly schedules initial appointments for members seeking care or identifies appropriate providers with availability to see members.
• Follows up with members after initial appointment to confirm member’s positive experience or help member identify alternatives.
• Follows up with members after 4-6 weeks of care to confirm services are meeting member’s needs.
• Facilitates clinical consultation with BH case manager/care coordinator as needed to address barriers to treatment progress.
• Facilitates coordination of care with member’s primary care provider.
• Identifies concerns related to social determinants of health and assists members in connecting with appropriate resources.
• Cultivates and maintains good working relationships with providers.
• Communicates regularly with contracted providers and keeps apprised of providers’ availability to see new patients.
• Provides exceptional customer service to providers to resolve issues with claims, credentialing, contracting.
• Verifies providers’ demographics, availability and clinical expertise and ensures data in Moda systems including CaseTrakker Dynamo and Facets are up to date and accurate. Updates data in CaseTrakker Dynamo and sends information to provider configuration for Facets as needed.
• Assists BH Clinical Liaison in identifying providers amenable to value-based contracting.
• Maintains close communication and coordination with members of Behavioral Health and Care 360 teams.
• Identifies, assesses, and recommends opportunities for process and workflow improvements within Behavioral Health and Care 360 teams.
• Coordinates with Contracting and Provider Relations teams regarding contracting issues for behavioral health providers.
• Completes benefit exceptions and single case agreements as appropriate using approved processes.
• Assists members and providers in resolving issues related to access or reimbursement for BH services.
• Documents member and provider contacts with thorough notes in Facets and Dynamo.
• Exercises judgment, initiative, and discretion in confidential and sensitive matters.
• Maintains and always assures client confidentiality.
• Other duties as assigned.

Working Conditions & Contact With Others

• Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need.
• Internally with Behavioral Health, Care 360, Claims, Customer Service, HealthCare Services, Information Technology, Sales and Account Services, Government Programs, and Contracting/Provider Relations. Externally with members, providers, community resources, and office staff.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler and Danielle Baker via our [e-mail] email.