Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for gathering attestation and validation on the accuracy of provider network data as displayed in our local directories to ensure they have the ability for the services, benefits, and programs as well as understand their rights and responsibilities. This position is also responsible for compliance for all DOBI, CMS and NCQA accuracy regulations.
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Makes outbound validation calls to providers in order to assure of demographic practitioner detail for each practice location for all Horizon networks.
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Contacts members regarding preventive health activities.
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Receives inbound services calls and provide accurate complete information in response to provider inquiries, complaints and problems within a timely fashion.
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Contact provider offices to encourage ongoing education and dialogue on data management best practices to service member/patient needs and to attend scheduled orientation sessions and other educational and outreach activities.
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Conducts provider surveys and assessments as applicable.
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Act as liaison with providers, members and outside community resources.
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Handle PCP/PCD changes for members.
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Verification of PCP/PCD and member eligibility with Providers.
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Maintain call documentation in databases with relevant information regarding special outreach projects in accordance with departmental focus and objectives.
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Assist provider offices with issues associated to credentialing, recredentialing, claims and provider data maintenance by providing guidance on how to proceed with the process.
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:
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High School Diploma/GED required.
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Requires a minimum of 3 years of experience in customer service, telephone sales preferably in a Managed Care environment.
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Some experience with provider practices, physicians and/or office managers in a healthcare, group practice setting.
Knowledge:
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Prefers knowledge of Horizon products and services
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Requires knowledge of health insurance industry
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Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes
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Should be knowledgeable in the use of intranet and internet applications.
Skills and Abilities:
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Requires excellent oral and written communication skills.
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Requires strong interpersonal and organization skills.
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Requires ability to resolve problems.
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:
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Comprehensive health benefits (Medical/Dental/Vision)
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Retirement Plans
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Generous PTO
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Incentive Plans
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Wellness Programs
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Paid Volunteer Time Off
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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.
What We Do
Horizon Blue Cross Blue Shield of New Jersey- the state’s largest and oldest health insurer - is a subsidiary of Horizon Mutual Holdings, Inc., a not-for-profit mutual holding company.
Together with its affiliates, Horizon provides a wide array of medical, dental, vision and prescription insurance products and services. As New Jersey’ health solutions leader, Horizon is transforming healthcare by working with doctors and hospitals to deliver innovative, patient-centered programs that improve quality and lower costs. It is headquartered in Newark, NJ with offices in Wall and Hopewell, NJ.
Horizon serves 3.7 million members including more than 1 million who rely on Medicaid for their health coverage.
