Behavioral Health Specialist

ICONMA; Remote; ZAR 837 000 - 1 173 000; Full time

Job summary

A healthcare services company based in Charlestown is looking for a Behavioral Health Specialist to manage authorization requests and collaborate with healthcare providers. The successful candidate will have an Associate’s Degree in Healthcare or related field, with at least 2 years of experience in a high-volume healthcare setting. This role demands excellent communication skills, the ability to prioritize tasks effectively, and proficiency in relevant healthcare databases. The company offers health benefits, a referral program, and excellent advancement opportunities.

Benefits

Health Benefits

Referral Program

Growth opportunities

Qualifications

• 2+ years in high-volume healthcare office or related field.
• Familiarity with healthcare databases like FACETS.
• Behavioral health experience is a plus.

Responsibilities

• Manage incoming prior authorization and inpatient admission requests.
• Verify member eligibility and enter data into the Jiva system.
• Communicate with healthcare providers regarding authorization determinations.

Skills

Knowledge of medical terminology

Excellent communication skills

Teamwork and collaboration

Ability to prioritize tasks

Customer service focus

Education

Associate’s Degree in Healthcare or related area

Tools

Jiva

Microsoft Office

Job description

Our Client, a Medical Center company, is looking for a Behavioral Health Specialist for their Charlestown, MA/ Remote location.

Responsibilities

• The Behavioral Health Specialist is responsible for managing incoming prior authorization and inpatient admission requests for behavioral health services. This role involves reviewing submissions, gathering clinical documentation from providers, verifying member eligibility, and entering information into the Jiva system. The specialist ensures requests are routed appropriately to the clinical team, communicates determinations, resolves escalated issues, and collaborates closely with behavioral health clinicians to support timely and accurate decision-making.
• Manages and prioritizes incoming behavioral health authorization and inpatient admission requests; processes designated services in accordance with departmental protocols and routes cases appropriately to the behavioral health clinical team.
• Verifies member eligibility and enters all required data into the Jiva system with accuracy and efficiency to ensure compliance with turnaround time standards.
• Communicates with healthcare providers to request, clarify, or follow up on clinical information necessary for authorization determinations.
• Oversees incoming requests received through Jiva, fax, and email, ensuring accurate data entry and consistent adherence to established workflows and quality standards.
• Consistently meets or exceeds productivity benchmarks while maintaining compliance with regulatory and internal turnaround time requirements.
• Notifies providers of authorization decisions, addresses escalated provider inquiries, and ensures clear, professional, and timely communication at all times.
• Collaborates with internal departments to enhance understanding of the authorization process and maintains up-to-date knowledge of departmental policies, procedures, and system functionalities.
• Actively participates in team functions, including case triage, shared inbox and voicemail management, and department meetings.

Requirements

• Associate’s Degree in Healthcare, Nursing, Social Work or related area, or the equivalent combination of training and experience is required.
• Knowledge of medical terminology.
• A minimum of 2 years of experience in a high-volume healthcare office, hospital administration, data entry office, or customer service call center.
• Familiarity with Jiva, FACETS, or other healthcare databases.
• Experience working in health plan utilization or claims processing.
• Previous customer service experience is desirable.
• Behavioral Health experience.
• Proven ability to prioritize and manage multiple tasks in a fast-paced environment while meeting deadlines.
• Capacity to process high volumes of requests accurately.
• Excellent listening, verbal, and written communication skills and a strong customer service focus.
• Teamwork and collaboration skills.
• Proficiency in Microsoft Office products.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.