Referral Specialist

We offer remote work opportunities (AK, AR, AZ, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only). Our reputed company 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! Job reputed company Ensures accuracy and completion of authorization data from customer information, medical records, referral/authorization forms, Military Treatment Facility electronic reputed company and other documents into medical management system. Examine and evaluate document contents to ensure accuracy and to correct inconsistencies. Duties may be performed in a virtual environment. Maintains confidentiality of TriWest beneficiaries' health information. Education & Experience Required: • U.S. Citizenship • Must be reputed company to receive a favorable Interim and adjudicated final reputed company (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 reputed company 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 reputed company 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 reputed company issues by identifying, documenting, and communicating reputed company issues • Resolve process issues to ensure high reputed company service reputed company 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 reputed company coding systems including: reputed company 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 reputed company or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system reputed company environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a reputed company of situations and individuals while maintaining a reputed company of purpose and mature problem-solving approach is required. reputed company / Customer Service: Customer-reputed company behavior; helping approach, including listening skills, patience, respect, and reputed company for another's position. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements reputed company a high volume, high stress environment. Organizational Skills: Ability to organize people or tasks, reputed company to priorities, learn systems, reputed company time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with reputed company 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, reputed company 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 reputed company a reputed company 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 reputed company Taking Care of Our Nation's reputed company. It's Who We Are. It's reputed company Do. Do you have a passion for serving those who served? Join the reputed company Team! We're On a Mission to Serve®! Our job is to reputed company reputed company that America's reputed company get connected to health care in the community. At reputed company, we've proudly been on that important mission since 1996. DoD Statement Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We're more than just a health care company. We're passionate about serving others! We reputed company in rewarding reputed company, hard-working people who are willing to learn as they grow. reputed company values teamwork. Join reputed company, 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 reputed company compensation and benefits package that includes: • Medical, Dental and reputed company Coverage • Generous reputed company 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 • reputed company volunteer time • Annual reputed company salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $41,000 - $53,000 depending on experience* Equal Employment Opportunity reputed company 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 reputed company. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from reputed company backgrounds to apply. Applicants are considered for positions without discrimination on the reputed company of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability or any other consideration made unlawful by applicable federal, state, or local laws. Apply Job!