Healthcare Operations Specialist

2 days ago

Spokane, Washington, United States TriWest Healthcare Alliance Full time
Job Summary

This position resides within 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.

The incumbent will also provide TRICARE educational briefings upon request and assist the Regional Director and other applicable MVS staff with support for the MTF(s) contingency exercises or actual contingency scenarios.

This position will report to the MVS Regional Director and may require travel to multiple MTFs or regional TriWest hubs.

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.
  • Reviews and facilitates 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.

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