Job Information
Blue Cross and Blue Shield of Louisiana Population Health Outreach Specialist in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
Grade 05
POSITION PURPOSE
Responsible for researching, resolving, and coordinating operational assignments/projects, including but not limited to, training, budgetary responsibilities, accounts payables, special projects, accreditation and compliance activity. Assist Care Management staff with coordination of population health activities for members, provides oversight of reimbursement accuracy for specially negotiating cases and assist in discharge planning, negotiating cases, arranging services, initiating authorizations, triaging calls, training and fulfillment and documentation. Coordinates population health activities for members via inbound and outbound calls to members to engage, educate and transfer for enrollment in programs and or re-connect those lost to contact. Assists clinical staff in discharge outreach planning and coordination, creating episodes/activities in care management system, arranging services and working reports as needed.
NATURE AND SCOPE
This role does not manage people
This role reports to this job: MANAGER, CLINICAL TRAINING - CARE MANAGEMENT;MANAGER, POPULATION HEALTH
Necessary Contacts: All levels of BCBSLA personnel, providers, subscribers, governmental agencies, members and providers.
QUALIFICATIONS
Education
High School Diploma or equivalent is required
Two years of college is preferred
Work Experience
3 years of general health insurance, managed care experience and/or prior customer service is required
1 year of experience communicating with members about clinical topics is required
4 years of work experience where duties include problem solving and customer satisfaction preferred
Clinical office experience preferred
Skills and Abilities
Excellent oral/written communication skills with strong interviewing skills and working knowledge of medical terminology are required
Must have effective interpersonal skills to handle numerous inquiries in professional manner with tact, diplomacy and patience.
Excellent listening skills are required to effectively handle customer’s needs/issues and demonstrate the ability to multi-task, prioritize work assignments and work independently.
Working knowledge of relevant software and proficiency in Microsoft word and excel are required
Requires the demonstrated ability to identify, make recommendations and take action on opportunities and potential operational efficiencies within the unit and offer solutions and recommendations to management.
Ability to adhere to defined metrics for monitoring work and preparation of reports to reflect work efforts are required to complete tasks/projects.
Workplace attitude must embrace customer centric behavior, organizational cultural beliefs and divisional requirements including efficiency, accuracy, adherence and confidentiality of information.
Punctual and regular attendance is required
Licenses and Certifications
- Certification in a medical related field preferred
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Works closely with management and staff to facilitate and participate in operational activities, research and implementation of program enhancements, compliance monitoring, accreditation, reinsurance and budgetary activities.
Acts as a resource to Care Management training unit for researching, assisting with the delivery of system implementation and general internal and external training activities and maintaining, coordinating and documenting routine staffing activities related to employee satisfaction.
Provides Population Health administrative support which include accurate, timely program data entry, responding to benefit inquiries, completing care coordination activities delegated by clinical staff and maintaining all documentation and reports as determined by management.
Supports clinical team by researching current and new resource capabilities to identify efficiencies and quality solutions for fulfillment, documentation and member interactions.
Handles routine telephone calls, visitors and incoming and outgoing correspondence received by the Population Health teams and makes outbound telephone calls based on need of targeted population, including but not limited to, QBPC provider and member outreach call and screening for newly onboarded members.
Acts as a resource to Care Management clinical teams in assisting with meaningful member outreach activities, assisting with targeted outreach projects to members and providers that will enhance member engagement in qualifying programs.
Responsible for meeting targets for staff and unit performance as required by company and management standards.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
#LI_CB1
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Customer Service & Contact Center Operations