Posted: Tuesday, November 7, 2017 4:52 PM
Job DescriptionDirectly interacts with a variety of customers daily. Processes healthcare authorizations approved by VA, places outbound calls and receives calls to schedule Veterans’ appointments. Ensures accurate data entry and completion of authorization data from referral/authorization forms, medical documentation, existing data contained in the TriWest medical management system and customer information. Contacts providers to obtain missing medical documentation to assure compliance with timelines. Provides back-up by phone to facilitate patient transfers as requested by VA. Works in a detailed, multi-tasked and fast-paced production environment.Education & ExperienceRequired: o High School diploma or GE Do At least one fullyear experience working in a call center and/or medical appointing in a medical officeo Experience using Microsoft Office, the Internet and medical/health systemso Knowledge of medical terminology normally obtained through a medical certification OR work experience using and understanding ICD and CPT codesPreferred: o More than two years experience working in a call center and/or medical appointing in a medical officeCollege coursework in the healthcare or equivalent fieldKey Responsibilitieso Researches and contacts the VA POC for essential missing information that cannot be located in the TriWest medical management system.o Schedules appointments for Veterans using the medical management appointing function for specialty care in the provider network in accordance with VA guidelines and TriWest desk procedures.o Manages multiple tasks lists in accordance with directed timelines.o Initiates automated or live outbound phone calls to Veterans and providers within timelines.o Contacts network providers to schedule, reschedule or cancel Veterans’ appointments.o Consistently displays professional and courteous service skills to internal and external customers.o Utilizes various software applicationso Understands procedures and processes of the VA program o Responds to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes providing details about referrals, authorizations, and the location and use of network providers and when necessary redirect to the VA for further healthcare services.o Demonstrates proficiency with the medical management system for tracking and updating medical documentation from the network providers for every patient encounter.o Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI). PHI is any information about health status, or healthcare services that is linked to an individual.o Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries' health information.o Tracks, receives, reviews medical information for completeness in accordance with VA and TriWest requirements.o Confirms medical documentation is received and complete to allow payment of a claim.o Documents every aspect of appointing, patient transfers, inquiries or complaints thoroughly in the medical management system.o Documents all communications involving Veteran and provider contacts.o Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialist and other departments .o Receives and reviews faxed documents to ensure appropriate entry into the medical management system.o Understands and utilizes the grievances and appeals process available to dissatisfied beneficiaries and providers.o Identifies potential discrepancies in the medical management system to assure quality program compliance.o Consistently meets department productivity and performance metrics.o Performs other duties as assigned.o Regular and reliable attendance is required.CompetenciesCommitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.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.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.Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.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: Proficient data entry skills; Ability to achieve a Meets Expectations rating or higher on monthly production bonus scorecardCompany DescriptionTaking Care of our Nation's Heroes. It's Who We Are. It's What We Do.Since our founding in 1996, TriWest Healthcare Alliance has been On a Mission to Serve our nation's Veterans and military community.For 17 years, we administered the Department of Defense TRICARE program. We have been proud to serve those who wear America's uniform, those who came before them and their family members. Today, we are privileged to support the health care needs of our nation's Veterans, offering access to quality provider networks and excellent customer service through the Veterans Choice Program.
• Location: Sacramento
• Post ID: 20067332 sacramento