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Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!
We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)
Job Summary
Reviews medical documentation to determine correct coding on submitted medical and behavioral health claims utilizing appropriate clinical staff resources as needed to assist in review. Update authorizations as necessary with appropriate codes.
Education & Experience
Key Responsibilities
Conducts medical documentation review to determine appropriateness of coding of service
o Validates medical determinations through research of resources including regulatory manuals, computer files and documentation.
o Assists in preparation of cases for program payment or medical director review as indicated.
o Validates all appropriate data is supplied with program invoice.
o Reviews Authorization data for process improvements
o Ensures contract compliance for timelines regarding resolution of medical documentation review and updates
o Communicates effectively with management and peers.
o Consistently meets quotas for position
o Identifies and reports any potential quality or fraud issues to management, Quality Management or Program Integrity as needed.
o Provides support regarding clinical and coding questions.
o Performs other duties as assigned.
o Regular and reliable attendance is required.
Competencies
Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.
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, 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.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Thorough knowledge of policies and procedures, Managed Care concepts and medical terminology. Proficient with claim and coding tools such as Find-a-Code, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Ability to meet or exceed production standards in compliance with contract.
Working Conditions
Working Conditions:
o Favorable working conditions in a climate controlled office space; must be available to cover any work shift; works within an office environment with minimal travel required; level II IT security clearance.
o Extensive computer work with prolonged sitting.
o Security clearance as required by contract.
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.
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:
*Annual base salary for Colorado, Hawaii and Washington State residents: $46,000 - $51,000 depending on experience*
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.
Full Time
Ancillary Healthcare
$45k-56k (estimate)
03/25/2024
07/20/2024
triwest.com
PHOENIX, AZ
3,000 - 7,500
1996
$200M - $500M
Ancillary Healthcare
On a Mission to Serve TriWest Healthcare Alliance was formed in 1996 as the only company of its kind, with one sole purpose that continues today serving the health care needs of the military and Veteran communities. Since our founding in 1996, TriWest Healthcare Alliance has been On a Mission to Serve our nation's Veteran and military communities. For 17 years, we administered the Department of Defense TRICARE program. We have been proud to serve those who wear America's uniform, those who came before them, and their family members. Today, we are privileged to support the health care needs of... our nation's Veterans, offering access to quality provider networks and excellent customer service through the Department of Veterans Affairs (VA) Community Care Network Region 4 contract. Doing Whatever It Takes! not only is our corporate motto, it is a deep-rooted desire to go above and beyond for our customers, because we understand and honor them. We Respect the Military Culture. We Honor the Sacrifices Made. We are Committed to Providing the Service Our Customers Deserve. Our team members many of whom are Veterans or military family members are committed to providing superior service to our nation's heroes. The medical providers in our network and our business partners strive to continually support the military and Veteran communities and exceed customer expectations. TriWest offers a wide variety of career options in areas such as Project Management, Administrative, Patient Services, Medical Operations, IT, Finance, Business Development, Data Services, and Customer Service, and many more. Learn how you can make a difference in the lives of Veterans at https://www.TriWest.com/joinourteam. https://www.facebook.com/TriWest/ https://twitter.com/TriWest https://www.instagram.com/triwesthealthcarealliance/
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