Member Services After Care Coordinator

JOB DESCRIPTION:

The Member Service Representative/Aftercare Coordinator (MSR/AF) is the front line interface to Members and Providers who seek information about behavioral health benefits. The MSR/AF coordinates appropriate care for members following discharge.   The MSR/AF assists callers by providing benefit and eligibility information and referrals to network providers.  The MSR/AF transfers clinical calls to clinicians, as defined in the transfer protocol.  In addition, the MSR/AF will be responsible for completing specified assignments that assist the department in meeting contractual goals.

 

PRIMARY RESPONSIBILITIES

 

1.   Staffs Member Service ACD queues 

2.   Respond to questions about eligibility, benefits and procedures for accessing behavioral health services

3.   Respond to requests for referrals to network providers

4.   Determine which calls need to be transferred to a clinician, as defined in transfer protocols

5.   Enter authorizations for extended outpatient sessions

6.   Research and resolve PA discrepancies 

7.   Tracks discharges and aftercare activity for all members that are discharged from inpatient mental health/adult, inpatient mental health/child, child/adolescent ART and partial hospital programs.  This includes, calling the member beginning 2 days prior to his/her outpatient appointment to remind them of their appointment; this includes first appointments following discharge for partial hospitalization, structured outpatient addiction programs, day treatment, intensive outpatient treatment, family stabilization, routine outpatient and appointments with PCP’s

8.   Calling the servicing provider to determine if the member kept his/her appointment

9.   Sending letters and calling members that did not make it to his/her appointment

10.   Entering all aftercare information into the FlexCare aftercare tracking database

11.   Maintaining the aftercare tracking database and reporting results to the Director of Quality on a regular basis

12.   Assists members and providers in accessing post-discharge aftercare appointments, when appropriate

13.   Works with facilities and network to resolve access issues or other provider-based reasons for not meeting the 7-day standard, other than member refusing 

14.   Other duties as assigned

 

Send Resumes and Salary Requirements:

employment@beaconhs.com

Fax: 781-994-7641