Remote Provider Services Specialist: Claims & Support

Vaya Health; Raleigh (NC); Remote; USD 42,000 - 62,000; Full time

Job summary

Vaya Health seeks an ACCESS Provider Services Specialist for a remote home-based role in North Carolina, requiring residency within NC or within 40 miles of the border. The candidate will handle provider inquiries about claims, contracts, authorizations, and benefits, performing triage and guiding callers through resources.

Responsibilities include documenting interactions, educating providers on tools, and coordinating with multiple departments while maintaining confidentiality and PHI

Qualifications

• Bachelor's degree in a Human Services field with at least two years of relevant experience, or a Bachelor’s degree with four years of experience in community mental health settings.
• Must be qualified as a Qualified Professional per 10A NCAC 27G .0104
• Knowledge of MH/SU/DD service arrays and Medicaid waivers is essential.

Responsibilities

• Handle telephonic requests from network providers and provide information on inquiries, concerns, and questions
• Perform initial triage to determine appropriate call handling
• Educate providers on resources available through Provider Central
• Provide navigational support for forms, training guides, and contracting information
• Authenticate providers and route calls to appropriate workgroups for assistance
• Update materials and act as a subject matter expert for call center operations
• Document calls and follow-up activities in the electronic system

Skills

Phone support

Provider education

Triage

Interdepartmental liaison

Documentation

Education

Bachelor's in Human Services

Experience with adults/children MH/ID/MH services

Tools

Provider Central

Job description

Vaya Health seeks an ACCESS Provider Services Specialist for a remote home-based role in North Carolina, requiring residency within NC or within 40 miles of the border. The candidate will handle provider inquiries about claims, contracts, authorizations, and benefits, performing triage and guiding callers through resources.

Responsibilities include documenting interactions, educating providers on tools, and coordinating with multiple departments while maintaining confidentiality and PHI