Healthcare Operations Specialist; AR, IA, IL, MN, MO, LA, WI

We offer remote work opportunities (AR, IA, IL, MN, MO, LA, WI).

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!

The Healthcare Operations Specialist provides non-clinical support to Tri West healthcare operations teams, supporting the access to care our military community deserves. The Specialist regularly collaborates with Tri West (TW) staff, providers, beneficiaries, their families, and other team members to complete daily operational tasks. This work includes data entry and task processing in medical management and customer relationship management (CRM) systems, and making and receiving telephone calls, including participation in outreach campaigns.

Along with ensuring accuracy and efficiency, this role requires significant attention to detail, the ability to prioritize and organize work, and regular assessment of current workflows to create efficiencies. Duties are primarily performed in a virtual work environment using collaboration tools and platforms.

• High School Diploma or G.E.D.
• U.S. Citizenship
• 3+ years of administrative experience in a medical office, health insurance, or managed care operations setting, or equivalent
• Proficient with Microsoft Office suite
• Proficient data entry skills and ability to effectively navigate multiple IT applications
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation

• Medical Assistant (MA) or Certified Nursing Assistant (CNA)
• Knowledge of Medical Terminology
• Prior experience in a Managed Care Organization (MCO)
• Prior experience with TRICARE or VA health plans

• Proactively evaluate and process assigned tasks within the medical management and CRM systems in accordance with desk procedures and defined rules.
• Manage and complete requests for registration in various programs in collaboration with supported staff (care management, enrollment, credentialing, etc.).
• Handle incoming and outgoing phone calls in an efficient and professional manner, including inbound phone queues for calls related to medical management programs and provider inquiries.
• Conduct telephone outreach to secure medical documentation and, within defined outreach campaigns, provide information and facilitate registration for medical management programs available to beneficiaries.
• Utilize standard program processes to respond to beneficiary, provider, and staff requests.
• Support the assigned TW operations leadership team by coordinating tasks and day-to-day activities, as requested.
• Take appropriate measures to comply with HIPAA regulations to protect the privacy of beneficiaries’ personally identifiable information (PII) and protected health information (PHI).
• Efficiently identify and resolve issues or address barriers to daily work.
• Foster cross-functional communication with other organizational teams and departments.
• Ability to work independently and collaboratively in a fast-paced environment.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

• Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.
• Communication / People
  
  Skills:
  
  Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
• Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TEAMs, Tri West Intranet, the Internet, and department software applications.
• Empathy / Customer Service: Customer-focused behavior;
  Helping approach, including listening skills, patience, respect, and empathy for another's position. Respectful behavior when working with a diverse population and workforce.
• Independent Thinking / Self-Initiative: Critical thinker with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without considerable direction and to find necessary resources.
• Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, sometimes demanding environment.
• Organizational
  
  Skills:
  
  Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
• Problem Solving /…