Behavioral Health Veteran Representative

Job Summary:

Provides outstanding customer service related to Veteran care through the Community Care Network (CCN) in a detailed, fast-paced contact center. Handles inbound and places outbound phone calls from/to Veterans, providers, VA and other customers to obtain and communicate appointment information. Reviews and enters complex authorizations and referrals from VA and providers. Processes healthcare authorizations received from the VA or directly from the Veteran and places outbound calls and receives calls to schedule Veterans’ appointments. Ensures accurate data entry and completion of authorization from referral/authorization forms, medical documentation Contacts providers to obtain missing medical documentation to assure compliance with timelines. Effectively communicates medical information, test results, diagnoses and or proposed treatment in a manner easily understood by the Veteran.

Works in a detailed, fast-paced production environment.

Education and Experience:

Required

• High School diploma or G.E.D.
• At least one full year experience working in an inbound/outbound call center and/or medical appointing
• Experience using Microsoft Office, the Internet and medical/health systems
• Knowledge of medical terminology normally obtained through a medical certification OR work experience using and understanding ICD and CPT codes

Preferred

• Military experience focusing on service delivery
  • More than two years of experience working in a call center and or/medical appointing in a medical office OR College coursework in healthcare or equivalent field

KEY RESPONSIBILITIES

• Review and respond to complex referral requests from VA and civilian providers with appropriate coding and provider selection.
• Researches and contacts the VA POC for essential missing information that cannot be located in the TriWest medical management system.
• Enters referral requests into the medical management system with appropriate coding and provider selection.
• Responds to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes referrals, authorizations, and the location and use of network and certified providers.
• Answers inbound calls from Veterans and providers in a timely manner
• Consistently displays professional and courteous service skills to internal and external customers.
• Schedules appointments for Veterans using the medical management appointing function for specialty care in the provider network in accordance with VA guidelines and TriWest desk procedures.
• Contacts network providers to schedule, reschedule or cancel Veterans’ appointments.
• Works with standard coding systems including: standard medical taxonomy, International Classification for Diseases, Current Procedural Terminology, and Health Care Common Procedure Coding System.
• Demonstrates proficiency with the medical management system for tracking and updating medical documentation from the network providers for every patient encounter.
• Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI). PHI is any information about health status, or healthcare services that is linked to an individual.
• Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries' health information.
• Tracks, receives, reviews medical information for completeness in accordance with VA and TriWest requirements.
• Documents every aspect of appointing, patient transfers, inquiries or complaints thoroughly in the medical management system.
• Documents all communications involving Veteran and provider contacts.
• Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialist and other departments
• Receives and reviews faxed documents to ensure appropriate entry into the medical management system.
• Understands and utilizes the grievances and appeals process available to dissatisfied beneficiaries and providers.
• Identifies potential discrepancies in the medical management system to assure quality program compliance.
• Consistently meets department productivity and performance metrics.
• Performs other duties as assigned.
• Regular and reliable attendance is required

Competencies:

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.

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

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.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Working knowledge of medical terminology and the authorization and referral process; Telephone customer service and analysis skills; Proficient with data entry into on-line systems; Ability to cope in a fast-paced production environment and to effectively utilize multiple systems to perform function.