This position will support the following military treatment facility:
Evans-Fort Carson, US Air Force Academy, Peterson Space Force Base.Our Department of Defense contract requires US citizenship and a favorably
adjudicated DOD background investigation for this position.Veterans, Reservists, Guardsmen and military family members are encouraged
to apply!Must have US. Citizenship.Job SummaryThis 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 also 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. Additionally, the incumbent will 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.
Dependent on location, the incumbent may be required to travel to multiple
MTFs, or regional TriWest hubs.Education & ExperienceRequired: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: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.Key ResponsibilitiesDevelops 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 nrollment,
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
