Field Support Specialist - Hybrid - San Diego, CA

About the role

This position resides within the Military and 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.

This position requires frequent coordination with Provider Relation Representatives to determine TRICARE certified healthcare locations for patient care. 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.

Responsibilities

• Develops and maintains a clear understanding of TriWest’s contracted responsibilities, the TRICARE Operations Manual, 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, beneficiary claims and any other related matters.
• Utilizing the TriWest customer relationship management system (CRM), DOMA, Government Portal, DEERS and Tableau 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.
• 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.
• 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.

Requirements

• 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.

Qualifications

• 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.
• Experience working in CARE Radius, DOMA (Document Management System), DEER (Defense Enrollment Eligibility Reporting System).

Skills

• Working knowledge of medical terminology and the authorization and referral process;
• Advanced telephone customer service and analysis skills;
• Proficient with data entry into on-line systems;
• Ability to cope in a fast-paced production environment and to effectively utilize multiple systems to perform function.

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

Pay

$81,000 - $85,000 per year

Schedule

Regular and reliable attendance is required.