The Personal Health Assistant - Community-Based (PHA) supports members through an integrated approach that combines care coordination and community outreach. The PHA is responsible for helping members navigate and access physician services, healthcare services, community services, and other resources, as well as answer or address benefit and health plan questions, to assist the member in maintaining and/or achieving healthcare treatment and healthcare status goals.
Possess solid knowledge base for community resources and services to provide referrals to members for local services/community agencies as appropriate. Exhibit excellent working relations with members and staff, effectively communicating goals and objectives of PHA services program.
Assist member, and if needed, serve as a liaison between the member and community service organizations. Identify members who may need clinical triage, assessment and intervention, and immediately notify the clinical team member for guidance and next steps.
Resolve problems including, but not limited to billing, claims and benefit issues and assisting patients with resolution within various departments within the organization.
Identify providers and physicians to meet the needs of the assigned member to fit their specific needs for treatment.
Refer and assist members with appointment scheduling for services, providers and facilities for needed healthcare appointments, services and appointment reminders.
Accountable for maintaining members treatment and healthcare goals by identifying challenges to member's ability to access healthcare services.
Contact, engage and communicate with assigned members.
Proactively refer members to Case Management, Chronic Care Program or other Horizon programs that they would benefit from.
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.
Understanding of the community served and community connectivity required
Medical terminology knowledge required
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, Outlook, Lync, and PowerPoint); Should be knowledgeable in the use of intranet and internet applications.
Skills and Abilities:
Requires good communication skills, such as listening well, strong interpersonal communication skills and the ability to explain healthcare terminology i.e., co-pays, primary care physician, patient-centered care, etc., (not clinical terminology), to a lay audience.
Requires ability to use a personal computer and applicable software and systems.
Requires ability to make sound decisions under the direction of Supervisor
Requires strong analytical and interpersonal skills
Prefers experience working in a customer service, healthcare setting, or community-based setting.
Prefers the ability to analyze and resolve problems with minimal supervision
Requires a minimum of 1 year experience in customer service in healthcare industry.
Prefer 2 years' experience in a Managed Care company.
Prefer 2 years' experience in medical billing and claims coding/processing
Strongly prefer Bilingual: English/Spanish
Additional licensing, certifications, registrations:
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.
Location: Newark, NJ
Activation Date: Monday, September 24, 2018
Expiration Date: Thursday, November 1, 2018
Horizon Blue Cross Blue Shield