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.

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
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.

Network Outreach Specialist I

Key skills