Behavioral Health Outreach Call Center RepresentativePrimary Location: Moon township, PA
Additional Locations: PA-Moon township Apply
- Facilitates provider and member outreach to ensure member receipt of important clinical services to improvement member health outcomes.
- Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services.
- Position is a behavioral health position which requires outreach to members and providers.
- Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
- Makes outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes.
- Identifies when to refer member to Social Worker or Case Manager.
- Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.).
- Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
- Documents member participation in outreach activities in accordance with abstraction and audit standards.
- Conducts HEDIS provider chart request calls and mailings.
- May develop and maintain member incentive programs to support HEDIS initiatives.
- Maintains incentive database to track member compliance.
- Records and documents all member and provider outreach activity.
- Performs other duties as required.
- Ability to use standard corporate software packages and corporate applications.
- Strong communication.
- Recent and related experience working with HEDIS criteria.
- Ability to work independently.
- Experience working in call center environment.
- Minimum 3 years' recent and related health care marketing, outreach and/or health education.
- Bachelor's degree or equivalent experience.
- Prefer degree or experience to be in a behavioral health field.
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