Member Services Representative

Position Overview: The Member Services Representative is responsible for responding to incoming calls from CBH members, their families, in and out of network providers and other outside sources regarding behavioral health services. The Member Services Representative conducts face to face interviews with members, checks insurance eligibility, makes referrals for outpatient appointments, assists in grievances and complaints process, participates in community relations events, attends ongoing trainings, and actively participates in ongoing meetings and projects involving DBH/CBH initiatives. Member Services Representatives are advocates for CBH members and assist them in negotiating the behavioral health and drug and alcohol systems. Essential Functions: With supervision a Member Services Representative will perform the following functions: Guide telephone callers in navigating through behavioral health and drug and alcohol systems of DBH, IDS and CBH. Meet with members and their care givers on-site and in the community who may have mental health and drug and alcohol diagnoses. Refer members to appropriate levels of care and act as a liaison between members and providers. Directing members in obtaining health insurance and guiding members through conflicts with behavioral health Medicaid insurance. Research network opportunities and out of network resources for members as needed. Advocate for members when needed; be the member ''voice''. Maintain detailed documentation of all interactions with members.Adhere to client confidentiality in accordance with HIPPA guidelines. Schedule assessments, evaluations, interpretation, aftercare appointments, complaints, grievances, appointment reminders and other member requests. Attend grievances and complaint hearings as an advocate for our members. Cross collaboration with other DBH, IDS and CBH departments. Address members with serious mental health or suicidal situations if needed. Availability to work during the weekend as needed. Represent DBH/IDS/CBH professionally at all times. Position Requirements: Education: Bachelor''s Degree in a related field or a high school diploma with 2 years of experience in the field. License/Certification: Certifications in Crisis Intervention, Autism, MAT and Customer Service are a plus. Relevant Work Experience: a minimum of 2 years of mental health and/or substance abuse experience. Proof of COVID vaccination required Skills:Basic proficiency in Microsoft Word and Excel; ability to input data at a minimum of 20 WPM.Excellent telephone communication and customer service skills. Ability to learn quickly.Adaptability, availability to work weekend or essential staff shifts if needed. Ability to speak a second language preferred.Able to effectively solve problems with limited consultation with a supervisor.Good listening skills.Ability to demonstrate leadership and serve as a role model. Ability to work as part of a team; build relationships internally and externally. Self evaluate and accept feedback. Ability to navigate crisis situations. Forward thinking. Ability to understand how Member Services fits into DBH/IDS. Equal Employment Opportunity: Community Behavioral Health (CBH) provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, gender identity, sexual orientation, individual genetic information or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function.Americans with Disabilities Act: Applicants as well as employers who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case in accordance with applicable law. This job profile reflects management''s assignment of current duties, responsibilities, and essential functions; it does not prescribe all or restrict the tasks that may be assigned now, or in the future, relevant to the responsibilities for this position. Community Behavioral Health (CBH) may change the specific job duties with or without prior notice based on the needs of the organization.

Created: 2021-11-29