Field Support Specialist

4 weeks ago

Del Rio, Texas, United States TriWest Healthcare Alliance Full time
Job Summary

This position is part of the Military and Veteran Services (MVS) division, supporting the internal staff of military treatment facilities (MTFs). The incumbent will work closely with MTF staff to provide non-clinical support for patient referrals and authorizations, outreach to network providers, and facilitate the support of applicable TriWest departments for resolving network gaps, provider and contract concerns, customer service requests, and discharge coordination for patients from network and non-network facilities.

Key Responsibilities
  • Develops and maintains a clear understanding of TriWest's contracted responsibilities and performance requirements related to support of the MTFs and their beneficiaries.
  • Serves as the designated onsite/on call TriWest point of contact for the MTF staff regarding any of a continuum of issues relating to enrollment, referrals and authorizations, issues with network providers, and any other related matters.
  • Utilizing the TriWest customer relationship management system (CRM), will refer all identified issues to the appropriate TriWest corporate division for follow up and resolution according to MVS operating procedures.
  • Monitors issues referred to them for trends or opportunities to improve TriWest's services and identify root causes of frequently recurring matters referred to them, keeping the Regional Director and associated MVS team members informed in accordance with MVS policies and procedures.
  • Review and facilitate resolution of referral and authorization issues and trends, analyzing them for root causes and work with the MTF staff to identify and implement corrective strategies.
  • Provides TRICARE information/education briefings for meetings with MTF staff, providers, medical staff and beneficiary groups and provides accurate explanations of the various TRICARE health plans and their policies relating to them.
  • Performs on-site and virtual outreach activities for military installation community and beneficiary groups such as Family Readiness Groups, Retiree Associations, and Installation New-comers Orientation, and provides educational briefings on such matters as transferring TRICARE enrollment, PCM selection, and other interest areas for new people to the community.
  • Documents and records performance of educational briefings provided for input to contract performance reporting in accordance with MVS policy and procedures.
  • Works in partnership with the MTF staff to identify and develop opportunities, within job scope, for greater MTF optimization in support of Defense Health Agency (DHA) Network goals.
  • Responds to and assists MTF staff, the Regional Director, and other involved MVS team members with contingency planning for MTF contingency exercises or actual contingency scenarios in support of the MTF and TriWest contracted network providers as needed.
  • Maintains up-to-date knowledge of the Managed Care Support Contract, contract changes, the TRICARE Operations Manual (TOM), and TriWest policies and procedures applicable to this position.
  • Maintains proficiency in the use of TriWest's customer relationship management (CRM) system and ensures it is used to record and report all applicable customer service transactions and the reporting of identified issues to other TriWest corporate departments for resolution.
  • Inputs potential quality of care or safety issues in to CRM and reports them to the Regional Director and applicable TriWest departments in accordance with MVS policy and procedures.
  • Consistently meets productivity and performance metrics determined by TriWest and MVS policy and procedures.
Requirements
  • High School Diploma or General Education Diploma (GED).
  • US Citizenship.
  • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
  • 2 or more years of experience in working with the TRICARE Program in customer service and administrative support to clinical operations and providers services or equivalent roles.
  • Demonstrated success working in a highly matrixed organizational environment.
Preferred Qualifications
  • Bachelor's Degree in a health related studies (Health Administration, Health Policy, Public Health, Public Administration or Communications).
  • Experience as a TRICARE Beneficiary Counseling and Assistance Coordinator (BCAC).
  • Experience working in MTF TRICARE business operations.

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