Job Description:

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 Department of Defense 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 Summary

Provides support and information to internal Military Veteran Services (MVS) and external Military Treatment Facility (MTF) customers related to Enrollment topics, including eligibility, enrollment, complex fee-related enrollments, status changes, reinstatements, refunds, fees, split-enrollments, and dis-enrollments. Responsible for maintaining an effective relationship with MTF staff by assisting with Enrollment related issues, processing enrollments, and capacity requests. Also assists with coordination of 100 mile waivers, MTF Enrollment Guidelines, MTF Bulk Enrollment spread sheets, and MTF exception to policy guidelines.

Education & Experience

Required:

• High School diploma or G.E.D
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
• TRICARE enrollment experience
• Proven experience in providing excellent and professional customer service
• Intermediate level of Microsoft Word, Excel, and PowerPoint

Preferred:

• Associates degree or equivalent
• 4 years' experience in an administrative or medical office experience
• 2+ years recent TRICARE enrollment experience
• Prior experience as a team lead or subject matter expert

Key Responsibilities

• Provides the MTF commanders with expert TRICARE enrollment direction and advice to maximize their TRICARE healthcare delivery to their enrolled population.
• Provides assistance with the maintenance of MTF Enrollment guidelines and provides timely responses to guideline updates.
• Delivers troubleshooting support for Department of Defense (DoD) systems as it relates to TRICARE enrollment transactions or activities.
• Utilizes advanced research techniques for problem-solving enrollment issues to include Patient Information Transfer (PIT) errors, CHCS Panel issues and MTF and civilian provider capacity issues.
• Manages the timely completion of issues by tracking, reporting, and resolving. Responsible for maintaining the accuracy and currency of the logs for reporting purposes.
• Processes MTF provider panel moves via the DEERS PCM Online Research tool within contract compliance time frames.
• Collaborates with MTF on preventative tactics to avoid capacity and enrollment issues within the MTF.
• Analyzes information received from the TRICARE Regional Office (TRO) and updates the TriWest ZIP tool, as appropriate.

• Reviews enrollment guideline update requests submitted by MTF staff, clarifies intent with the MTF and processes documentation for the implementation of the guideline updates.
• Coordinates civilian capacity increases with Provider Services and MTF provider capacity issues with MTF staff.
• Researches, problem solves, and processes more complex fee-related enrollments, status changes, reinstatements, refunds, fees, split-enrollments, and dis-enrollments.
• Communicates with other TriWest staff to resolve complex issues.
• Coordinates with Claims department to reprocess claims for reinstated beneficiaries.
• Responds to incoming calls/e-mails/correspondence/faxes and provides timely resolutions to issues. Informs stakeholders of Enrollment changes and follows and provides reminders as needed.
• Responds to incoming calls/e-mails/correspondence/faxes and provides timely resolutions to issues. Informs stakeholders of Enrollment changes and follows and provides reminders as needed.
• Assists in the documentation of established policies and procedures.
• Defines and implements processes and best practices to ensure quality assurance. Prepares and maintains desk procedures on how to work error and production reports.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively fosters actions required for desired business outcomes through ongoing constructive feedback.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapts to different styles; listens critically; collaborates.

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.

Information Management: Ability to manage large amounts of complex information easily, communicates clearly, and draws sound conclusions.

Multi-Tasking / Time Management: Prioritizes and manages actions to meet changing deadlines and requirements within a high volume, high stress environment.

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: Influences the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Thorough knowledge of TRICARE program, policies and procedures; proficient with Defense Enrollment Eligibility Reporting System; knowledge of Enrollment-related software applications.

Working Conditions

Working Conditions:

• Availability to cover any work shift
• Works within a standard office environment, with minimal travel

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense 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 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


• Generous 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

*Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $47,000 - $60,000 depending on experience*

Equal Employment Opportunity

TriWest Healthcare Alliance 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 success. 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 all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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