Chenega Corporation · 4 hours ago
Referral Specialist
NM
Full-time
Remote
Entry Level
2+ years exp
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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
Qualification
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Required
High School Diploma or G.E.D.
2+ years’ experience in a health care customer service environment
Experience with Microsoft Office
Knowledge of medical terminology
Managed Care experience
TRICARE experience
Company
Chenega Corporation
As the most successful Alaska Native village corporation, Chenega figures prominently in the diverse government services contracting marketplace supporting defense, intelligence, and federal civilian customers.
5,001-10,000 employees
Funding
Current Stage
Late StageLeadership Team
Robb Milne
CFO
Chris Andersen
Chief Development Officer, Military, Intel and Operations Support Strategic Business Unit
Company data provided by crunchbase
