Tricare Field Rep Ii Co/wy
TriWest Healthcare Alliance (Colorado Springs, Colorado)

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COMPANY OVERVIEW We are looking for MANAGED CARE EXPERIENCE, TRAINING OR PRESENTATION EXPERIENCE, and EXCELLENT COMMUNICATION SKILLS. 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. DOD STATEMENT 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. JOB SUMMARY/DESCRIPTION Job Summary: This position is responsible for overseeing the customer service and education of non-network (non-contracted) providers in a given service area. This includes conducting extensive educational and frequent contact primarily through office visits throughout the service area, entering all provider contacts in a tracking database, keeping current and following TRICARE, TriWest, and departmental policies and procedures and submitting reports in a timely manner. This position also conducts formal, bi-annual seminars and military treatment facility briefings, attends military Prime Service Area Executive Council meetings, and works closely with the network subcontractors in their assigned territory. Key Responsibility Areas: o Deliver training courses throughout the service area required by TRICARE, identified by provider needs assessment, TriWest identified issues, or assigned by Manager Provider Relations & Education (Manager). o Recommend future educational needs based on observations of and discussions with non-network (non-contracted) providers in the service area. o Visit the top 10% non-network institutional high volume providers (based on volume of unique beneficiaries) within the service area at least once annually. If the top 10% is fewer than ten (10), the top 10 (ten) providers will be visited. o Visit the top 10% non-network professional high volume providers (based on volume of unique beneficiaries) within the service area at least once annually. If the top 10% is fewer than forty (40) professional providers, then the top forty (40) will be visited. o Visit an average of thirty (30) non-network (non-contracted) providers monthly. o Provide feedback to management of any claims processing, referral/authorization, or other unfavorable trends. Specific examples, with sufficient detail, should be cited to assist in the resolution of the problem. o Analyze and refer issues identified through provider contacts through proper channels for resolution. o Establish and maintain effective communications with TRICARE Hub and Field Operations staff in assigned service area. o Complete written monthly summary report in a timely manner to the Manager. o Maintain accurate provider contact records in the West Region Desktop Application (WRDA). o Submit all seminar evaluation results to the Provider Data Specialist in a timely manner. o Maintain professional working relationship with other TriWest departments, network subcontractors, and military treatment facilities to stay abreast of provider educational needs and product changes. o Establish effective relationships with medical societies, medical associations, hospital associations and other health care associations. o Actively promote electronic claims submission in all provider interactions. o Remain current on all TRICARE, TriWest and departmental policies and procedures by taking all available training and reviewing e-mailed, TriNet, and www.triwest.com communications. o Participating in virtual teams to discuss process improvement opportunities, issues resolution, or other assigned tasks. o Assist/participate in projects as assigned by Manager. o Perform other duties as assigned. Working Conditions: Favorable working conditions in a climate controlled office space; must be able to travel (locally or distant with overnight stays) a minimum of forty (40) percent and maximum of ninety (90) percent of the time, based on seasonal needs; must be able to lift a minimum of 20 lbs; must be able to work under stressful conditions; must be able to obtain appropriate DITSCAP security clearance. QUALIFICATIONS Employment Standards: Education and Experience: o Bachelor's (BA/BS) Degree in Healthcare or related field, Health Insurance Association of America (HIAA) designation or equivalent experience. o A minimum of two (2) years documented training/group presentation experience. o Three (3) years managed health care (provider relations and/or provider education) or customer service experience background, with increasing responsibility. Knowledge, Skills and Abilities: o Computer literacy (Proficiency in Windows applications, Excel) o Lifting requirements (equipment and course material). o Excellent oral and written communication skills. o Ability to work under pressure and prioritize multiple tasks. o Ability and willingness to travel extensively. o Knowledge of TRICARE and the military health care system preferred. o Experience working detailed claims issues through research of claims system. o Planning and organizational skills required to manage training, facilitate group discussions, conduct research, and conduct other job responsibilities. o Group presentation skills required to teach courses using various training techniques and mediums. BENEFITS 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 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.