Education & Experience Required:

U.S. Citizenship
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
High School Diploma or G.E.D.
1 + year experience in health care operations performing data entry or customer service
Experience with

Microsoft Office Preferred:

Referral and authorization processing experience
Knowledge of medical terminology obtained through medical assistant certification or experience interpreting and applying ICD and CPT codes
Managed Care experience
TRICARE experience
Veteran or military spouse or military affiliated Key Responsibilities
Assesses tasks for authorization/referral request to ensure accurate entry into the medical management system.
Identifies potential discrepancies in the medical management system to assure quality compliance.
Consistently meets department productivity and performance metrics.
Follow HIPAA compliance and TriWest confidentially guidelines.
Refers beneficiaries to network providers.
Resolves issues to complete care request.
Reads and comprehends diagnosis, procedures and requested service on incoming care requests.
Assists with resolving data quality issues by identifying, documenting, and communicating quality issues
Resolve process issues to ensure high quality service levels throughout TriWest. Seeks advice and escalates issues or problems as warranted.
Processes referrals for Behavioral Health, Specialty Care, Durable Medical Equipment, Inpatient Admissions, Military Treatment Facilities, and Urgent referral and authorization requests.
Assesses electronic documents to ensure appropriate entry into the medical management system.
Works with standard coding systems including: standard medical taxonomy, ICD-10, CPT and HCPCS codes.
Verifies beneficiary eligibility and ensures appropriate referral procedures are followed for the various types of TRICARE beneficiaries.
Ensures procedures are followed for referrals based on beneficiary eligibility type, geographical location, and on the provider's request.
Processes authorization requests and referral requests in the on-line medical management system.
Communicates with other departments, medical providers, and beneficiaries to clarify documentation prior to processing.
Performs other duties as assigned.
Regular and reliable attendance is required.

Competencies Communication /

People Skills:

Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy:

Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping /

Flexibility:

Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Empathy /

Customer Service:

Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. Multi-Tasking /

Time Management:

Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

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.

Technical Skills:

Knowledge of TRICARE and the Military Health System programs; ability to use CHCS booking procedures, ATC standards and established clinic capability/booking protocols.

Working Conditions Working Conditions:

Ability to cover any work shift
Ability to work overtime, if needed

Onsite:

Works within a standard office environment

Remote:

Private and secure workspace and workstation with high speed internet is required

Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone 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®! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996. 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 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 TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $42, 000 to $47, 000 per year. 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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. 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