New Directions Behavioral Health, founded in 1995, is dedicated to helping people find a healthy balance and improve health through positive change. We offer managed behavioral healthcare, employee assistance, organizational consulting, and health coaching programs.
As behavior change experts, we provide a full range of proven practices to help individuals attain healthier and more balanced lifestyles. In fact, we serve the behavioral health needs of millions of people in Kansas, Missouri, Arkansas, and across the nation.
New Directions is the fastest growing behavioral health care company. Our services have earned national recognition and awards for innovation and best practices. And we are accredited by NCQA as an MBHO and by URAC for utilization management and case management.
New Directions Behavioral Health is seeking a Customer Service Team Leader for our Kansas City office to p rovide assistance to the Managers of Customer Service in answering CSR questions and assist with training, and auditing of CSRs as requested. Performs CSR activities for Member/Client and Provider services including: Verification of member demographic, assistance in claims inquiries, education, benefits determination, appeals inquires , EAP and MBH referrals and scheduling of appointments. The customer service representative is not responsible for conducting any utilization management activities that require interpretation of clinical information.
The Customer Team Leader’s Key Responsibilities include:
Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct, and Compliance Program
Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information
Adheres to the New Directions Behavioral Health Policies
Take initial calls from Clients/Members and Providers. Verify demographic information and benefits.
Follows scripted clinical questions for routine referrals and triages calls to Clinical Resource Center Triage department when risk is identified.
Answer administrative questions from Clients/Members and Providers i.e. where to send claims, claim inquiries, benefits, product information
Work closely with Network Development staff regarding provider issues, network needs, locating Providers and communication
Work closely with Appeals Coordinators related to appeals inquires.
Work closely with Account Management staff surrounding company needs/request
Process paperwork for addition of new Providers/Practitioners to the Provider Search System in OPTAMUM
Interface with EAP Clinical staff
Prepare paperwork for EAP affiliate referrals
Assist in mentoring/training Customer Service Representative I and II including: policies, desk top procedures and departmental operations guidelines (DOGS), quoting benefits and eligibility per product, handling claims call; call authentication; providing routine referrals; asking risk questions; appropriate triage to other departments/staff; claims, documentation, systems applications, teleset use, and business processes.
Assist manager in customer service telecom reporting
Assist in the development of instructor-lead training curricula
Tracks completion of training
Determines with the department Managers and Director, performance gaps based required procedures, customer feedback and observations.
Coordinates logistics for training sessions (i.e., location, equipment, materials, communication)
Keeps up to date on areas of content expertise through ongoing education, review of New Directions’ policies and procedures, and regular communication with subject matter experts and department management.
Provides coaching and feedback.
Other duties as assigned
- High School Diploma with 5 or more years customer service or claims processing experience
- Proven written and oral communication skills, organizational skills, demonstrated willingness to work within a collaborative, team-oriented environment
- Will be proficient in data processing and understand user aspects of information systems
- Bachelor’s degree in a behavioral health related field with 2 years customers service or claims processing experience
- Bilingual/Spanish - Proficiency in English required & strongly prefer proficiency in Spanish
If you’re ready to join a team of professionals that are dedicated to making a difference, we want to hear from you!
New Directions Behavioral Health is an Equal Opportunity Employer M/D/V/F.
We offer a very competitive compensation and benefits package.
For consideration, please apply on-line at www.ndbh.com/careers.