Transition Care Specialist

2 weeks ago

Phoenix, United States Blue Cross Blue Shield of Arizona Full time

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
- Responsible for outreach to members and collaboration with a multi-disciplinary care team to facilitate positive health outcomes post hospitalization. The role of the Transition Care Specialist is to support the clinical care manager are prohibited from conducting evaluations or interpretations of clinical data. The Transition Care Specialist position is a non-clinical administrative staff position which does not require licensure or certification. The care managers provide support guidance and direction to ensure the Transition Care Specialist have the tools and the resources necessary to support the needs of the care manager's.
- REQUIRED QUALIFICATIONS
- Required Work Experience
- 3 years of experience in healthcare, health insurance, or related customer service
- Required Education
- High-School Diploma or GED in general field of study
- PREFERRED QUALIFICATIONS

Preferred Work Experience
- 2 years of physician office experience
- 2 years of care management or care coordination experience
- Bi-lingual: Spanish and English

Preferred Education
- Associate's Degree in general field of study or post high school technical courses in a health related field

Preferred Licenses
- N/A

Preferred Certifications
- Certified Medical Assistant
- ESSENTIAL job functions AND RESPONSIBILITIES
- Outreach to members to obtain demographics, collect self-reported health information and document all information accurately.
- Follow outreach scripting and algorithm for care transition calls
- Assist member as needed with community resources, appointment scheduling, and coordination of supplies/equipment/home health, locating providers, and benefit information as needed.
- Collaborate with the clinical team and refer members as applicable for health related issues.
- Follow-up with members as needed.
- Collaborate with the interdisciplinary care team to support member and the team as needed.
- Provide assistance to members for questions, concerns, providers or the care delivery system.
- Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.
- Answer a diverse and high volume of health insurance customer calls or correspondence on a daily basis.
- Maintain complete and accurate records per department policy.
- Meet quality, quantity and timeliness standards to achieve individual and departmental performance goals as defined within the department guidelines.
- Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
- Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
- Research, gather and conduct preliminary analysis of data for department and corporate reporting.
- Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
- Ensure confidentiality and control access to sensitive information.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.

competencies

REQUIRED COMPETENCIES

Required Job Skills
- Intermediate understanding of medical terminology
- Intermediate PC proficiency
- Intermediate skill in word processing, spreadsheet, and database software

Required Professional Competencies
- Promote a positive attitude and work enviroment
- Strong interpersonal and communication skills (written and verbal)
- Maintain confidentiality and privacy
- Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards
- Interpret and translate policies, procedures, programs and guidelines
- Capable of investigative research
- Follow and accept instruction and direction
- Establish and maintain working relationships in a collaborative team environment

Required Leadership Experience and Competencies
- N/A

PREFERRED COMPETENCIES

Preferred Job Skills
- Intermediate comprehension of anatomy and medical practices
- Intermediate skills with health management systems and/or electronic medical records

Preferred Professional Competencies
- Demonstrated ability to utilize motivational interviewing
- Analytical knowledge necessary to generate reports based on available data and then make decisions based on rep

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