Network Outreach Specialist I

About the position

The Network Outreach Specialist I is responsible for ensuring the accuracy of provider network data displayed in local directories. This role involves gathering attestation and validation, making outbound calls to providers, and ensuring compliance with various regulations. The specialist acts as a liaison between providers, members, and community resources, while also assisting with credentialing and data management best practices.

Responsibilities
? Makes outbound validation calls to providers to assure demographic practitioner detail for each practice location for all Horizon networks.
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? Contacts members regarding preventive health activities.
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? Receives inbound service calls and provides accurate information in response to provider inquiries, complaints, and problems in a timely manner.
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? Encourages ongoing education and dialogue on data management best practices with provider offices.
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? Conducts provider surveys and assessments as applicable.
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? Acts as a liaison with providers, members, and outside community resources.
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? Handles PCP/PCD changes for members.
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? Verifies PCP/PCD and member eligibility with providers.
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? Maintains call documentation in databases regarding special outreach projects in accordance with departmental focus and objectives.
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? Assists provider offices with issues related to credentialing, recredentialing, claims, and provider data maintenance.

Requirements
? High School Diploma/GED required.
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? Minimum of 3 years of experience in customer service, preferably in a Managed Care environment.
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? Some experience with provider practices, physicians, and/or office managers in a healthcare setting.
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? Knowledge of Horizon products and services preferred.
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? Knowledge of the health insurance industry required.
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? Proficient in the use of personal computers and supporting software in a Windows-based environment, including MS Office products and Lotus Notes.
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? Knowledgeable in the use of intranet and internet applications.
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? Excellent oral and written communication skills required.
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? Strong interpersonal and organizational skills required.
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? Ability to resolve problems effectively.

Nice-to-haves
? Knowledge of Horizon products and services
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? Experience in a Managed Care environment

Benefits
? Comprehensive health benefits (Medical/Dental/Vision)
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? Retirement Plans
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? Generous PTO
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? Incentive Plans
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? Wellness Programs
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? Paid Volunteer Time Off
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? Tuition Reimbursement

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