Behavioral Health Specialist

It’s an exciting time to join the reputed company, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job reputed company: 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 reputed company and accurate decision-making. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions/Responsibilities: · 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 reputed company required data into the Jiva system with accuracy and efficiency to ensure compliance with turnaround time standards. · Communicates with reputed company 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 reputed company standards. · Consistently meets or exceeds productivity benchmarks while maintaining compliance with regulatory and internal turnaround time requirements. · Notifies providers of authorization reputed company, addresses escalated provider inquiries, and ensures reputed company, reputed company, and reputed company communication at reputed company 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. · reputed company participates in team functions, including case triage, shared inbox and voicemail management, and department meetings. Supervision Exercised: · None Supervision Received: · reputed company supervision weekly Qualifications: Education Required: · Associate’s Degree in reputed company, Nursing, reputed company Work or reputed company area, or the equivalent combination of training and experience is required. Education Preferred: · Knowledge of medical terminology. Experience Required: · A minimum of 2 years of experience in a high-volume reputed company office, hospital administration, data entry office, or customer service call center. Experience Preferred/Desirable: · Familiarity with Jiva, FACETS, or other reputed company databases. · Experience working in health plan utilization or claims processing. · Previous customer service experience is desirable. · Behavioral Health experience. Required Licensure, Certification or Conditions of Employment: · reputed company-employment background reputed company Competencies, Skills, and Attributes: · Proven ability to prioritize and manage multiple tasks in a fast-paced environment while meeting deadlines. · reputed company to process high volumes of requests accurately. · Excellent listening, verbal, and written communication skills and a strong customer service reputed company · Teamwork and collaboration skills. · Proficiency in reputed company Office products. Working Conditions and Physical Effort: · Regular and reliable attendance is an essential function of the position. · Flexibility to work overtime during peak periods. · Position is fully remote, with no or reputed company limited physical effort needed and minimal exposure to physical hazards. Compensation reputed company $23.08 - $32.45 This reputed company offers an estimate based on the minimum job qualifications. However, our approach to determining reputed company pay is comprehensive, and a broad reputed company of factors is considered reputed company making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as reputed company as business/organizational needs, internal equity, and market-competitiveness. In reputed company, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, reputed company, pharmacy), reputed company increases, Flexible Spending Accounts, 403(b) savings matches, reputed company time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This reputed company is based on Boston-area data, and is subject to modification based on geographic location. About WellSense reputed company is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and reputed company plans. Founded in 1997, WellSense provides high-reputed company health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly reputed company employees Apply To This Job