Healthcare Support Specialist

2 weeks ago

Anchorage, Alaska, 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.
  • 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

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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