Field Support Specialist

3 weeks ago

Lawton, Oklahoma, United States Triwest Healthcare Full time
Job Summary

This position is a critical component of the Military & Veteran Services (MVS) division, supporting the internal staff of military treatment facilities (MTFs) and providing non-clinical support for patient referrals and authorizations. The incumbent will work closely with MTF staff to 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.
Competencies
  • Commitment to Task: Ability to conform to established policies and procedures; exhibits high motivation.
  • Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
  • Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
  • Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
  • Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.
  • Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
  • Technical Skills: Working knowledge of medical terminology and the authorization and referral process; Advanced telephone customer service and analysis skills; Proficient with data entry into on-line systems; Ability to cope in a fast-paced production environment and to effectively utilize multiple systems to perform function.
Working Conditions

This position will require frequent travel and the incumbent may be required to work from home or from a specific MTF or TriWest hub. The incumbent will be expected to maintain availability to be reached by MTF staff or other TriWest team members via phone during normal working hours.

The incumbent will be required to work extensively with computer and telephone systems, and will be expected to maintain 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.

The incumbent will be expected to consistently meet productivity and performance metrics determined by TriWest and MVS policy and procedures.

Benefits

TriWest Healthcare Alliance offers a comprehensive and progressive compensation and benefits package, including medical, dental and vision coverage, generous paid time off, 401(k) retirement savings plan with matching, short-term and long-term disability, basic life, and accidental death and dismemberment insurance, tuition reimbursement, paid volunteer time, and annual base salary of $60,000 - $66,000 depending on experience.

TriWest Healthcare Alliance is an equal employment opportunity employer and is proud to have an inclusive work environment that cultivates and supports diversity at every organizational level.

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