Bay Pines, Florida
NOTE: This position is a work from home position but commutes 1-3x per week to the VA Medical Center in Bay Pines Florida. Applicant must be w/i 30-60 minute commute distance).
Embedded Support Specialist at TriWest Healthcare Alliance
Taking Care of Our Nation’s Veterans.
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.
Are you our next Embedded Support Specialist?
Do you find satisfaction in helping others? Do you enjoy working in a self-driven and dynamic environment? Do you thrive on challenge and take your responsibilities seriously? Are you looking for a job that is meaningful and rewarding?
If you enjoy problem solving, building account relationships, and delivering customer service in a collaborative environment, we have a position for you.
Our Embedded Support Specialists are:
Caring and Empathetic. You understand the needs of others and work hard to exceed their expectations.
Diligent. You work well within a clear set of expectations and guidelines but can overcome obstacles as needed.
Determined. You enjoy problem resolution and educating others to improve processes and the delivery of customer service and quality.
Thorough. You have a desire to get things done on time and with accuracy.
TriWest Embedded Support Specialists:
The Embedded Support Specialist serves as the primary point of contact between TriWest and our customer, the VA Medical Center Care, to effectively and efficiently support Veterans receiving care from a community provider. They are trained and knowledgeable on all aspects of program operations. Teams are embedded at the VAMC to offer day-to-day, face-to-face support for the VA staff members and Veterans (as requested) and to coordinate operational support with TriWest operations centers and corporate functions. Daily responsibilities for the TriWest staff include research and resolution of issues related to referrals, appointments, care coordination (non-clinical), secondary authorizations, and claims. Embedded staff also provide supplemental training and support to VA staff on the use of the TriWest VA Portal. Embedded staff will also work closely with TriWest Provider Services to research and resolve any provider network issues.
Some positions are fully embedded at the VA Medical Center (VAMC) while others are primarily working from home with frequent and regular visits and meetings onsite at the VAMC.
Service recovery with veterans, community providers and VA Medical Center staff when there are identified errors delaying care or payment of care or associated care (Emergency room/Inpatient) Claims received from third parties
Working in collaboration with the local VA Medical Center Advocates office to ensure issues are not escalated to the congressional level.
Working with the VA Medical Center Community Managed Care Team to reduce returns, resolve and maintain referral and authorization activity. Identify gaps in the TriWest network of licensed healthcare to deliver patient-centered care and with enrollment to update and maintain enrollment and eligibility information.
Support community Providers, ensuring the processing and payment of claims, identifying authorizations (not received by facility); possibly modifying authorizations requiring updating (CPT codes, secondary auth request education, secondary auth request inquiries and processing.
Follow processes of the Department of Veterans Affairs (VA) program and perform all tasks in a courteous and professional manner.
Protect the health care privacy of patients by strictly following HIPAA regulations.
Research systems to find missing information; coordinate with other TriWest departments to resolve issues.
Work in a variety of technologies to perform required tasks.
Manage prioritized tasks in a time-sensitive environment.
Perform other tasks as assigned by leadership.
Are you qualified?
Are you a Veteran, family member of a Veteran, a friend of a Veteran, or passionate about helping Veterans?
Do you have a high school diploma or G.E.D.?
How about at two years in working in a healthcare or managed care environment?
Do you have a year or more working in a customer service/resolution or account management role?
Are you proficient with a computer including Microsoft Office, the Internet, and other systems?
Do you have familiarity with medical terms or work experience understanding medical codes (if not, we can teach you)?
More About Working at TriWest Healthcare Alliance
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. Team members work from home or in one of our state-of-the-art facilities. 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
Equal Opportunity Employer
TriWest Healthcare Alliance is an equal employment opportunity employer. All qualified applicants are considered for employment, without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic made unlawful by applicable federal, state, or local laws.
Are you ready to make a difference in the lives of our nation’s heroes?