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Health System Specialist

4 months ago

Fort Sam Houston, United States Military Treatment Facilities Under Dha Full time

Manage an enrolled population of beneficiaries enrolled to multiple Patient Centered Medical Homes (PCMHs).
Educate MTF staff on the Supplemental Health Care Program (SHCP) used primarily to pay for private sector (purchased) care for active-duty uniformed service members.
Assist BAMC Referral Management Office with verification of covered services
Manage all aspects of the Tricare Plus Program including developing local policy, letter mail-outs and quality assurance checks to ensure compliance with enrollment requirements.
Serve as benefits counselor, providing dedicated service and assistance to Military Health System (MHS) beneficiaries in understanding and obtaining TRICARE benefits and services.
Review out of area referral and non-covered service requests, verifying direct care, local and network capability before submission to MTF leadership for approval.
Develop marketing plans that address beneficiary and provider education.