Personal Health Assistant

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

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.

Responsibilities:

• 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 members 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.

Education/Experience:

• High School Diploma/GED required.

• 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

Additional licensing, certifications, registrations:

• Requires a valid drivers license and access to transportation/vehicle.

Knowledge:

• 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

Travel:

• Significant travel depending on member base.

• Travel would be within a locally defined geographical area to meet with members, healthcare partners and other stakeholders as required.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

$55,400 - $74,130

​This compensation ra