Remote Behavioral Health Access Specialist

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

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.