Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
The Personal Health Assistant - Community-Based (PHA) supports members through an integrated approach that combines care coordination and community outreach. The PHA is responsible for helping members navigate and access physician services, healthcare services, community services, and other resources, as well as answer or address benefit and health plan questions, to assist the member in maintaining and/or achieving healthcare treatment and healthcare status goals.
Responsibilities:
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Possess solid knowledge base for community resources and services to provide referrals to members for local services/community agencies as appropriate.
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Exhibit excellent working relations with members and staff, effectively communicating goals and objectives of PHA services program.
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Assist member, and if needed, serve as a liaison between the member and community service organizations.
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Identify members who may need clinical triage, assessment and intervention, and immediately notify the clinical team member for guidance and next steps.
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Resolve problems including, but not limited to billing, claims and benefit issues and assisting patients with resolution within various departments within the organization.
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Identify providers and physicians to meet the needs of the assigned member to fit their specific needs for treatment.
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Refer and assist members with appointment scheduling for services, providers and facilities for needed healthcare appointments, services and appointment reminders.
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Accountable for maintaining members treatment and healthcare goals by identifying challenges to members ability to access healthcare services.
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Contact, engage and communicate with assigned members.
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Proactively refer members to Case Management, Chronic Care Program or other Horizon programs that they would benefit from.
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 1 year experience in customer service in healthcare industry.
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Prefer 2 years experience in a Managed Care company.
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Prefer 2 years experience in medical billing and claims coding/processing
Additional licensing, certifications, registrations:
Knowledge:
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Understanding of the community served and community connectivity required
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Medical terminology knowledge required
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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, Outlook, Lync, and PowerPoint);
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Should be knowledgeable in the use of intranet and internet applications.
Skills and Abilities:
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Requires good communication skills, such as listening well, strong interpersonal communication skills and the ability to explain healthcare terminology i.e., co-pays, primary care physician, patient-centered care, etc., (not clinical terminology), to a lay audience.
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Requires ability to use a personal computer and applicable software and systems.
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Requires ability to make sound decisions under the direction of Supervisor
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Requires strong analytical and interpersonal skills
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Prefers experience working in a customer service, healthcare setting, or community-based setting.
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Prefers the ability to analyze and resolve problems with minimal supervision
Travel:
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Significant travel depending on member base.
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Travel would be within a locally defined geographical area to meet with members, healthcare partners and other stakeholders as required.
Salary Range:
$54,600 - $73,080
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:
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.
