Behavioral Health Care Coordination Specialist

Horizon Blue Cross Blue Shield of New Jersey; Hopewell (NJ); Vor Ort; USD 45.000 - 60.000; Vollzeit

Benefits dieser Stelle

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Zusammenfassung

Horizon Blue Cross Blue Shield of New Jersey is seeking a skilled team member to support Clinical Operations and serve as a liaison among Members, Physicians, Delegates, and Care Managers.

You will review service requests, collect data, route cases for clinical review, and coordinate benefits with providers and members. This role emphasizes accuracy, communication, and problem solving in a fast-paced environment.

Qualifikationen

• Knowledge of medical terminology.
• Strong written and oral communication skills.
• Ability to make sound decisions under supervision.
• Familiarity with contracts, enrollment, billing & claims processing.
• Knowledge of managed care principles.
• Strong analytical and interpersonal skills.

Aufgaben

• Review service requests for completeness and collect non-clinical data.
• Route cases for clinical review and coordinate benefits with members and providers.
• Coordinate case completion with physicians and members.
• Review medical, dental and vision claims and identify gaps in preventive care.
• Assist members with provider access and appointment logistics.
• Screen pre-certification requests from physicians/members under clinical oversight.
• Assist with finding providers and resolving member issues, including appeals.
• Review determination letters for accuracy and regulatory compliance.

Kenntnisse

Medical terminology

Oral and written communication

Decision making

Contracts enrollment billing claims

Managed Care

Analytical skills

Team player

Ausbildung

High School Diploma/GED

Jobbeschreibung

Horizon Blue Cross Blue Shield of New Jersey is seeking a skilled team member to support Clinical Operations and serve as a liaison among Members, Physicians, Delegates, and Care Managers.

You will review service requests, collect data, route cases for clinical review, and coordinate benefits with providers and members. This role emphasizes accuracy, communication, and problem solving in a fast-paced environment.