Job Description
Summary
Come join a company that strives for Extraordinary People and Exceptional Performance! Chenega Services & Federal Solutions, LLC, a Chenega Professional Services’ company, is looking for a fully remote Referral Specialist to ensure accuracy and completion of authorization data from customer information, medical records, referral/authorization forms, Military Treatment Facility electronic transmission and other documents into medical management system. Examine and evaluate document contents to ensure accuracy and to correct inconsistencies. Prioritizes referral/authorization submissions and forwards documents to appropriate parties for handling, and processing requests. Duties may be performed in a virtual environment. Maintains confidentiality of TriWest beneficiaries' health information.
Our company offers employees the opportunity to join a team where there is a robust employee benefits program, management engagement, quality leadership, an atmosphere of teamwork, recognition for performance, and promotion opportunities. We actively strive to channel our highly engaged employee’s knowledge, critical thinking, innovative solutions for our clients.
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 quality compliance.
- Consistently meet department productivity and performance metrics.
- Documents the receipt of returned correspondence via the medical management system.
- Follow HIPAA compliance and TriWest confidentially guidelines.
- Refers beneficiaries to network providers.
- Resolves issues to complete care request.
- Reads communications detailing diagnosis and requested services and procedures
- Assists in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management.
- Assists with resolving data quality issues by identifying, documenting, and communicating quality issues
- Resolve process issues to ensure high quality service levels throughout TriWest. Seeks advice and escalates issues or problem 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 standard coding systems including standard 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.
- Initiates the Knowledge Skills and Abilities process for the referrals, to ensure appropriate care is being requested at Military Treatment Facilities.
- Communicates with other departments, medical providers, and beneficiaries to clarify documentation prior to processing.
- Other duties as assigned
Qualifications
- High School Diploma or G.E.D.
- 2+ years’ experience in a health care customer service environment
- Experience with Microsoft Office
Knowledge, Skills and Abilities:
- Knowledge of medical terminology
- Managed Care experience
- TRICARE experience
Teleworking Permitted?
Yes
Teleworking Details
Fully Remote must have access to high speed internet
Estimated Salary/Wage
USD $20.00/Hr. Up to USD $23.00/Hr.
