L.A. Care Health Plan Behavioral Health Operations Specialist in Los Angeles, California

DUTIES The Behavioral Health Specialist is responsible for supporting several areas of the Behavioral Health Department, including direct contracts/vendor monitoring including, but not limited to, overseeing and participating trainings, supporting vendor processes and collaboration with internal departments. Analyzes and resolves complex problems dealing with claims, grievances and appeals and eligibility. Assist providers in submitting required reporting elements in a timely fashion, and assist providers in any provider incentive programs. The Specialist will also support the department with behavioral health related quality improvement, compliance, and regulatory support. Other specific program support would include the Autism Program, the IMD coordination and additional utilization management coordination.

QUALIFICATIONS AND REQUIREMENTS

Education Required High School Diploma

Preferred Bachelor's Degree in Health Services or related field.

Experience Required With High School Diploma: 5+ years of progressive provider services/relations experience with a health plan or medical group, knowledge of file review/auditing.

With Associate's Degree: 4 years of progressive provider services/relations experience with a health plan or medical group, knowledge of file review/auditing.

With Bachelor's Degree: 2-3 years of progressive provider services/relations experience with a health plan or medical group, knowledge of file review/auditing.

Work proactively in collaborate team environment. Strong organizational, multi-tasking and time management skills, Strong written and verbal communication skills, Lead and present in small and large group settings, Essential computer skills. Proficient with Microsoft Office, especially Word and Excel. Require experience providing excellent customer service,

Job Title: Behavioral Health Operations Specialist

Job Category: Administrative & Business Professionals

Department: Behavioral Health

Location: Headquarters, Downtown Los Angeles

Position Type: Full-time

Position Control Number: 2708

Pay Grade: I