Healthcare Support Specialist

1 month 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 support TRICARE beneficiaries and provide non-clinical support for patient referrals and authorizations, outreach to network providers as necessary, 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.
  • 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.
  • Performs other duties as assigned.
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.

Company Overview

Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team We're On a Mission to Serve

Benefits

We're more than just a health care company. We're passionate about serving others We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

  • 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

*Annual base salary: $66,000 - $73,000 depending on experience*

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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