Outreach Specialist I

at  Horizon Blue Cross Blue Shield of New Jersey

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for servicing and educating members on how to effectively utilize the services, benefits, and programs as well as understand their rights and responsibilities. Outreach Center Only: This position is also responsible for retention of membership and compliance to Medicaid and NJ FamilyCare regulations Care Management Only: This position is also responsible for the engagement of membership into Care Management and compliance with Medicaid contract requirements.

Responsibilities:

• Makes outbound welcome calls to members in order to assure understanding of how to effectively use health plan in accordance with company guidelines. Determine needs and make referrals to appropriate to Care/Case Management.
• Contacts members regarding preventive health activities.
• Receives inbound services calls and provide accurate complete information in response to members inquiries, complaints and problems within a timely fashion.
• Contact members to encourage members to obtain a baseline physical and dental examination and to attend scheduled orientation sessions and other educational and outreach activities.
• Conducts Member surveys and assessments.
• Act as liaison with providers, members and outside community resources.
• Handle PCP/PCD changes for members.
• Verification of PCP/PCD and member eligibility with Providers.
• Maintain call documentation in databases with relevant information regarding special outreach projects in accordance with departmental focus and objectives.
• Assist potential members with enrollment into the NJ FamilyCare program and provide guidance on how to proceed with the application process.
• Documents each encounter in the Medical Management System in accordance with departmental policy and documentation standards.
• Using the conference call feature assists member to make appointments with their PCP, specialists, Logisticare for transportation
• Triage and distribute referrals from Member Services in Trizetto and incoming faxes from providers.
• Create and complete authorizations in the medical management system based upon scripts and/or algorithms for review screening

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education/Experience:

• High School Diploma/GED required
• Requires three to five years customer services experience or telephone sales, preferably in a Managed Care environment.
• Prefers presentation and public speaking experience.

Knowledge:

• Requires knowledge of Horizon NJ Health products and services
• Requires knowledge of health insurance industry
• Requires knowledge of Medicaid programs and NJ FamilyCare program
• Requires knowledge of personal computers and related software.

Skills and Abilities:

• Requires excellent oral and written communication skills.
• Requires strong interpersonal and organization skills.
• Requires ability to resolve problems.
• Requires good PC skills

Salary Range:
$48,600 - $65,100

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process

• Makes outbound welcome calls to members in order to assure understanding of how to effectively use health plan in accordance with company guidelines. Determine needs and make referrals to appropriate to Care/Case Management.
• Contacts members regarding preventive health activities.
• Receives inbound services calls and provide accurate complete information in response to members inquiries, complaints and problems within a timely fashion.
• Contact members to encourage members to obtain a baseline physical and dental examination and to attend scheduled orientation sessions and other educational and outreach activities.
• Conducts Member surveys and assessments.
• Act as liaison with providers, members and outside community resources.
• Handle PCP/PCD changes for members.
• Verification of PCP/PCD and member eligibility with Providers.
• Maintain call documentation in databases with relevant information regarding special outreach projects in accordance with departmental focus and objectives.
• Assist potential members with enrollment into the NJ FamilyCare program and provide guidance on how to proceed with the application process.
• Documents each encounter in the Medical Management System in accordance with departmental policy and documentation standards.
• Using the conference call feature assists member to make appointments with their PCP, specialists, Logisticare for transportation
• Triage and distribute referrals from Member Services in Trizetto and incoming faxes from providers.
• Create and complete authorizations in the medical management system based upon scripts and/or algorithms for review screenin