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    Transition Care Specialist - Phoenix, United States - Blue Cross Blue Shield of Arizona

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

    3 weeks ago

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    Description

    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.
    • Demonstrate ability to apply plan policies and procedures effectively.
    • 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
    • Navigate, gather, input and maintain data records in multiple system applications
    • 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 reported data
    Preferred Leadership Experience and Competencies
    • Ability to build synergy and interdependence with a diverse team, in a changing environment
    Our Commitment

    AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

    Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see If interested in this position, please apply.
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