Field Support Specialist

2 weeks ago

Towanda, Kansas, United States Triwest Healthcare Full time
Job Summary

This position is responsible for providing support to military treatment facilities (MTFs) and their beneficiaries through the TRICARE program. The incumbent will work closely with MTF staff to resolve issues related to enrollment, referrals, and authorizations, as well as provide educational briefings on TRICARE health plans and policies.

Key Responsibilities
  • Develop and maintain a clear understanding of TriWest's contracted responsibilities and performance requirements related to support of MTFs and their beneficiaries.
  • Serve as the designated onsite/on-call TriWest point of contact for MTF staff regarding issues related to enrollment, referrals, and authorizations.
  • Utilize the TriWest customer relationship management system (CRM) to refer issues to the appropriate TriWest corporate division for follow-up and resolution.
  • Monitor issues referred to them for trends or opportunities to improve TriWest's services and identify root causes of frequently recurring matters.
  • Review and facilitate resolution of referral and authorization issues and trends, analyzing them for root causes and working with MTF staff to identify and implement corrective strategies.
  • Provide TRICARE information/education briefings for meetings with MTF staff, providers, medical staff, and beneficiary groups.
  • Perform on-site and virtual outreach activities for military installation community and beneficiary groups, providing educational briefings on matters such as transferring TRICARE enrollment, PCM selection, and other interest areas for new people to the community.
  • Document and record performance of educational briefings provided for input to contract performance reporting in accordance with MVS policy and procedures.
  • Work in partnership with MTF staff to identify and develop opportunities for greater MTF optimization in support of Defense Health Agency (DHA) Network goals.
  • Respond to and assist 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.
  • 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.
  • Maintain proficiency in the use of TriWest's customer relationship management (CRM) system and ensure 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.
  • Input potential quality of care or safety issues into CRM and report them to the Regional Director and applicable TriWest departments in accordance with MVS policy and procedures.
  • Consistently meet 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

Working conditions will vary and depend on the needs of the region the incumbent is supporting. This includes remote work with travel to MTFs and TriWest hubs, assignment to a specific MTF or a hybrid position with work from home and work within MTFs or hubs. Frequent travel is expected. Maintains availability to be reached by MTF staff or other TriWest team members via phone during normal working hours. Extensive computer and telephone work.

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