TRICARE Community Liaison 2

Profile

Description

Responsibilities

The TRICARE Community Liaison (TCL) 2 is a customer-facing Humana Military associate who is knowledgeable, professional and courteous. This role interacts with TRICARE beneficiaries; Medical Treatment Facility (MTF) and other Government staff, including senior military officers; and civilian healthcare providers and facilities in person and by other means, such as by telephone, e-mail, and chat. The primary focus of the TCL is to develop and sustain strong, collaborative relationships with all TRICARE customers in the East Region - Government, beneficiaries, and providers. The TCL must be cognizant of the military way of life during all interactions, including the impact of stress, trauma, and loss on active, reserve component and retired service members and their families that result from military operations. Assigned to cover specific Health System Areas comprised of Prime Service Areas (PSAs) and Non-Prime Service Areas (NPSAs), the associate's area of responsibility can average more than 62,000 beneficiaries, 8,000 network providers, and three to four MTFs within a geographic territory that may average 43,000 square miles. Through clear and concise communication, the TCL is responsible for ensuring MTF, beneficiary, and provider understanding of the TRICARE health plan and how to navigate the Military Health System. The TCL also supports the Health System Manager/Consultant in local TRICARE network operations, including participating in network development and optimization strategies which generate revenue for the company and increase healthcare trend and discount incentives paid by the Government. The TCL is self-directed and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquires and complicated problems and concerns raised by beneficiaries, providers, and Government customers. The TCL will provide back-up coverage in the absence of Health System Manager/Consultant. This position will require travel to conduct outreach activities.

KEY ACCOUNTABILITIES

Provide accurate explanation of TRICARE health plan policies and procedures during on-site and electronic beneficiary, provider, and Government outreach activities, ensuring compliance with all customer support performance standards for the dual purposes of maximizing TRICARE customer satisfaction and the incentives paid by the Government, and of sustaining Humana Military's competitive advantage for future contracts.

Respond in precise, comprehensive and timely manner to beneficiary, provider, and Government inquiries regarding eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics. Implement, track and complete self-managed tasks to process and correct uncomplicated general eligibility, enrollment, billing, claims, referral/ authorization, and network difficulties experienced by TRICARE customers.

Research and resolve difficult, complex TRICARE problems/issues elevated by a Government agent, beneficiary, or provider within required timelines. Implement self-directed activities to analyze, coordinate, process, and complete action to correct multifaceted problems relating to eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics.

Assist in developing and sustaining a high-performing network in designated PSAs/NSPAs which meets TRICARE and Humana Government Business requirements and optimization strategies. Contribute in procuring the network discount goal assigned to each PSA/NPSA that results in annual financial incentives awarded by the Government. Conduct regular and ad hoc market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to address any gaps in the network.

Accomplish all administrative tasks as assigned, including documenting interactions, processing transactions, and submitting required reports.

Respond to and assist in contingency operations in support of the MTF and network as needed. Conduct urgent market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to accommodate changes in MTF services.

Participate in activities that promote well-being and professional growth of self and others.

Required Qualifications

Our Department of Defense contract requires U.S. citizenship for this position

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Experience in customer relationship management, demonstrating courteous, professional interactions

Willingness to travel and work uncommon hours

Experience in analyzing information, researching problems, and determining and implementing solutions

Experience in healthcare provider relations

Excellent oral and written communication skills

Strong computer skills, including business software

Keen initiative and attention to detail

Exceptional public-speaking ability

Superior organizational skills necessary to effectively manage multiple activities

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Bachelor's degree

Three to four years' experience in TRICARE, including presentations to groups

Knowledge of healthcare provider contract negotiations

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com