Network Outreach Specialist I

About the Role

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.
What You'll Do

Responsibilities:
Makes outbound validation calls to providers in order to assure of demographic practitioner detail for each practice location for all Horizon networks.

Contacts members regarding preventive health activities.

Receives inbound services calls and provide accurate complete information in response to provider inquiries, complaints and problems within a timely fashion.

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.

Conducts provider surveys and assessments as applicable.

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 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.

What You Bring

Education/Experience:
High School Diploma/GED required.

Requires a minimum of 3 years of experience in customer service, telephone sales preferably in a Managed Care environment.

Some experience with provider practices, physicians and/or office managers in a healthcare, group practice setting.

Knowledge:
Prefers knowledge of Horizon products and services

Requires knowledge of health insurance industry

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

Should be knowledgeable in the use of intranet and internet applications.

Skills and Abilities:
Requires excellent oral and written communication skills.

Requires strong interpersonal and organization skills.

Requires ability to resolve problems.