Behavioral Health Operations Specialist

Company: CareSource
Location: Dayton
Posted on: November 19, 2024

Job Description:

Job Summary:The Behavioral Health Operations Specialist (BHOS) is responsible for building and maintaining positive relationships across all Behavioral Health (BH) providers in the state, including but not limited to: Community Behavioral Health Centers, Behavioral Health private practices, and Applied Behavioral Analysis (ABA) providers. In addition, the BHOS must have a deep knowledge and understanding of Behavioral Health benefits for all applicable products, billing, coding and prior authorization requirement/rules, and health partner lifecycle and claims process.Essential Functions:

• Provide a white glove approach when working with all Behavioral Health entities regarding operations barriers
• Work to effectively and efficiently address any and all BH provider operational issues impacting claims payment by:
  • Acting as the single accountable point of contact for a provider as assigned or identified
  • Developing and maintaining familiarity with all relevant internal technical systems and processes, including, but not limited to: Facets, Cactus, Choreo, ECHO, etc.
  • Submitting and tracking operations resolution tickets, such as SNOW tickets, through completion
  • Scheduling and hosting technical assistance calls and tracking follow-ups from said calls through completion
  • Developing and maintaining a familiarity with known system issue trends and their resolutions or the status or progress toward resolution and identifying potential system issues for escalation for resolution
  • Create and foster strong relationships with internal partners and be the subject matter expert on Behavioral Health operations
  • Utilize all available tools and resources, on a regular and frequent basis, to monitor provider quality around administrative Fraud, Waste, & Abuse and/or MCR quality concerns, and communicating about said quality issues with the appropriate external and internal entities, as appropriate
  • Identify opportunities for BH claim-related operational process or technical system training for both external and internal entities and developing and delivering trainings to both external and internal entities, as identified/requested/directed
  • Collaborate with operational, provider-facing, and clinical staff to implement all BH programs and initiatives in the Market
  • Collaborate with the Market BH Manager and Director on the development and execution of the BH Market Strategy
  • Perform maintenance tasks in designated system(s)
  • Complete behavioral health partner education, compliance, and/or complaint resolution
  • Regular travel to conduct provider visits, community-based visits, and attend conferences, as needed, to ensure effective administration of the program
  • Perform any other job duties as requestedEducation and Experience:
    • Bachelor's degree in business, communications, or related field or equivalent experience is required
    • A minimum of five (5) years of healthcare industry, account management or operations experience is required; experience in behavioral health and community behavioral health claims and operations is strongly preferred
    • Experience in a managed care organization is preferredCompetencies, Knowledge and Skills:
      • Intermediate proficiency level with Microsoft Outlook, Word, and Excel
      • Knowledge of BH system-of-care and billing practices, specifically community behavioral health
      • Knowledgeable of Cactus or other like credentialing system
      • Knowledge of various reimbursement methodologies to include capitation, per diems, discounts, value-based, etc.
      • Strong customer service skills
      • Excellent written and oral communication skills
      • Advanced problem-solving skills
      • Strong presentation skills
      • Strong interpersonal skills
      • Ability to work as a team
      • Ability to manage multiple projects and prioritize
      • Intermediate negotiation skills
      • Advanced research and analytical skills
      • Marketing competenciesLicensure and Certification:
        • Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in the position will be terminated
        • To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
        • CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.Working Conditions:
          • Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
          • Reside in the same territory they are assigned to work in; exceptions may be considered, due to business need
          • May be required to travel greater than 50% of time to perform work duties. A valid driver's license, car, and insurance are necessary for work related travel
          • Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
          • Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resourcesCompensation Range:
            $69,400.00 - $111,000.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:
            SalaryCompetencies:
            - Create an Inclusive Environment
            - Cultivate Partnerships
            - Develop Self and Others
            - Drive Execution
            - Influence Others
            - Pursue Personal Excellence
            - Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

Keywords: CareSource, Kettering , Behavioral Health Operations Specialist, Other , Dayton, Ohio