Field Support Specialist

4 weeks ago

Waynesville, United States Triwest Healthcare Full time
Job Summary

This position is part of the Military & Veteran Services (MVS) division and is assigned to support 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 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. Urgent matters will be reported via phone to the applicable Director/department as well as via the CRM system.
  • 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.
Working Conditions

This position will require frequent travel to multiple MTFs, or regional TriWest hubs. The incumbent may be required to work remotely with occasional on-site visits to MTFs or TriWest hubs. The position will require extensive computer and telephone work, with regular availability to be reached by MTF staff or other TriWest team members via phone during normal working hours.

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.
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.

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