Reports to and completes projects as assigned by Manager, Referral Management. Directs the Beneficiary Services Representative (BSR) staff in processing and production standards electronically submitted documents regarding health care authorizations and referral requests, including but not limited to initial data entry, problem resolution, and completion prior to clinical review. Functions as Subject Matter Expert for non-clinical aspects of the referral management process into TriWest medical management system and serves as the SME to other TriWest departments. Ensures contract compliance for the non-clinical aspects of data entry for the TRICARE West Region Contract. Serves as a role model for the Beneficiary Service Representatives in the areas of communication and customer service while performing all aspects of supervisory function (coaching, assessing performance etc). Collaborates with BSR Hub Specialist for staff training and quality assurance as well participation in process improvement activities.
Education & Experience
o Completion of the BSR Level 1-3 Tests and KSA (Knowledge, Skills, and Abilities) test within 90 days of hire.
o 1 year supervisory experience in a related filed or environment or degree in management field.
o High School Diploma or G.E.D.
o 2+ years experience in administrative or medical office or 1+ year college or equivalent.
o Experience in a health care customer service environment.
o Microsoft Office, including Outlook, Word and Excel.
o Experience with medical terminology and coding.
o 2+ years TRICARE experience.
o Managed Care experience.
o Balances workflow and supervises BSRs in the processing of health care authorizations and referral requests.
o Excels in training, leading and motivating people.
o Utilizes experienced employees to meet the daily workflow demands.
o Ensures staff is fully informed of procedural changes and significant events impacting workflow by coordinating staff meetings and sending email updates.
o Supports recruitment efforts by interviewing, selecting, and training new staff.
o Ensures the quality of BSR training in the Hub. Plans and implements orientation and training of newly hired employees.
o Coordinates staff training and staff development activities. Ensures department meets all training requirements.
o Assesses staff performance, advises and counsels, and conducts annual performance evaluations.
o Functions as the Subject Matter Expert TriWest regarding referral management process for both Med/Surg and general Behavioral Health as well as medical management system.
o Supports Healthcare Services by functioning in BSR role when needed.
o Resolves complex provider and beneficiary issues and communicates resolution with TriWest departments including Provider Services, Customer Service, Field Operations and MTFs.
o Ensures staff compliance with TRICARE contractual requirements.
o Represents Healthcare Services Referral Management in subcommittee as necessary.
o Collaborates with other departments, medical providers, and beneficiaries to ensure accurate documentation.
o Develops data to track department outcomes and prepares management reports as required.
o Participates in focused studies and performance improvement activities as required.
o Performs other duties as assigned.
o Regular and reliable attendance is required.
Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.
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.
Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
Leadership: Successfully manage different styles of employees; Provide clear direction and effective coaching.
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.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Thorough knowledge of TRICARE policies and procedures, data collection and reporting, TriWest's medical management systems, and Beneficiary Service Representative functions.
TriWest Healthcare Alliance, headquartered in Phoenix, Arizona, manages and administers quality healthcare services for our nation's active and retired uniformed military service members and their families, through a contract with the Department of Defense.
These individuals are eligible for the DoD's regionally managed health care program for the military, called TRICARE. TriWest manages and administers TRICARE throughout the 21-state TRICARE West Region.
In addition to supporting military families through the TRICARE program, TriWest has developed relationships with organizations such as the USO, Fisher House, the Women in Military Service for America Memorial Foundation and other military relief and support associations to strengthen America's military community locally and nationally.
TriWest provides state-of-the-art facilities, a smoke/tobacco-free, drug-free, business casual working environment, and offers a competitive compensation package including excellent benefits.
For more information about TriWest, please explore our website at www.triwest.com.
You are applying for a position that involves working on electronic systems that have access to Department of Defense ('DoD') systems. Therefore, you must undergo a DoD background investigation. This requires you to submit an application describing the previous 7 years of your life and to provide proof of U.S. citizenship in the form of a certified birth certificate, certificate of naturalization, current passport, form FS-240 or form DS-1350. This process takes several months to complete. During this time, the DoD will grant interim access to U.S. citizens allowing them to work for TriWest until their background investigation is completed. However, the DoD will not authorize interim access for non-U.S. citizens. If you are unable to obtain interim access or pass the background investigation, you are not qualified for this position and TriWest will withdraw any offer of employment or terminate your employment immediately.
TriWest offers a comprehensive and progressive benefits package that includes:
o Medical, dental and vision coverage
o Generous paid time off
o 401(k) Retirement Savings Plan (with matching)
o Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
o Voluntary plans such as pet insurance, long-term care and 529 College Savings Plans
o Reimbursement for various wellness initiatives
o Tuition reimbursement
Equal Employment Opportunity
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
TriWest Healthcare Alliance - 2 years ago