Outreach Representative

Company :

Highmark Inc.

Job Description :

JOB SUMMARY This job is responsible for serving as a liaison between the member, the Health Plan, and the relevant state and/or federal regulators. The position conducts telephonic support to assess member needs, provide appointment scheduling assistance, and educating members of their rights and responsibilities. This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and externally.

ESSENTIAL RESPONSIBILITIES Communicate effectively with staff, providers and members to accomplish business and member needs

Initiate outreach efforts, primarily by telephone, related to targeted preventive health initiatives:

Perform member education functions on the importance of targeted preventive health service

Recruit, holistically assess and enroll members into Disease Management Programs as appropriate

Assess opportunity for Care Management intervention and make appropriate referral

Contact members, providers and community agencies to coordinate access to preventive health services

Tracks all member and provider contacts in the appropriate computer systems for the purposes of data collection and record keeping

Participate in the development of outreach programs that are effective, measurable and innovative, with a special emphasis on reaching at risk members.

Other duties as assigned or requested.

EDUCATION Required

High School / GEDSubstitutions None Preferred Associate ’s DegreeEXPERIENCERequired1 year in Community Outreach or Customer Service Preferred Familiarity  with healthcare and/or insurance

Experience working with the Medicaid and/or Medicare populationLICENSES or CERTIFICATIONS Required None Preferred None SKILLS Must be proactive, self-directed, assertive and creative in problem solving and system planning

Strong active listening skills with the ability to act sensitively toward diverse people and situations .Ability to successfully interact with external customers, peers, colleagues, and management team Demonstrate effective time management skills and demonstrate an ability to prioritize and handle multiple tasks simultaneously

Must demonstrate sound judgment and discretion when approaching problems and making decisions

This position must be able to utilize sound and flexible productive work habits to set priorities, organize work and utilize time effectively

Must be aware of issues members face related to healthcare including transportation, child care, lack of knowledge concerning preventive health, distrust of the system as well as other personal, social, financial barriers

Must demonstrate patience and empathy when interacting with members and all internal/external customers

This job requires the ability to work independently and as a team member

Language (Other than English):

None Travel Requirement:0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)
Never Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement :
This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as…