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TRICARE Referral Specialist

Company: Centene Corporation
Location: Santa Fe
Posted on: June 25, 2022

Job Description:

Serve as a primary on-site referral/authorization (R/A) point of contact to Military Treatment Facilities (MTF) and Markets. Research and respond appropriately and timely to inquiries from MTF customers. Closely monitor delivery of customer service and support and resolving local R/A problems, issues and concerns. Recommend and implement strategies for resolving issues and improving service quality and timeliness. Process certain referral requests to completion. Educates MTF staff and network providers on submission of Referrals and Authorizations. Maintains database of local network providers on their access to care, preferred providers, and discount rates to leverage when processing.

+ Acts as the point of contact to military personnel at designated Military Treatment Facilities for referral submissions and processing to ensure local provider is available to treat and the beneficiary

+ Serves as the subject matter expert for the identification of local network access to care, preferred providers, provider capabilities, and discount rates to leverage for accurate referral submissions

+ Responsible for completing a cross-functional response for resolution of questions or referral issues during the authorization process. Identify and communicate any trends related to referral problems to OIM management, which also includes partnering with the local TRICARE Liaison to address systemic or local referral issues through early identification

+ Educates providers on HNFS and TRICARE policies and procedures related to referrals and web services when impacting a beneficiary's immediate access to care. Also provide consultation to providers regarding TRICARE clear and legible report submission requirements

+ Conduct regular, proactive outreach to local healthcare community to maintain record of current access to care, wait times, and provider capabilities


Associate's degree or equivalent experience required. Bachelor's preferred. Minimum of 2 years of experience working in association with, or for, a DoD Managed Care Support Contractor (TRICARE), Medicare/Medicaid Program, Commercial Healthcare Plan or Healthcare Provider/Group. Functional understanding of how any/all of the above healthcare programs work and their coordinator of benefits. Experience in customer relations, referral processing, and/or the TRICARE program preferred. Government Security/Clearance/Citizenship Requirements.Licensure/Certifications: Requires security clearance, CAC/NACThis position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security. _Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law._ **TITLE:** TRICARE Referral Specialist **LOCATION:** New Mexico, New Mexico **REQNUMBER:** 1331715

Keywords: Centene Corporation, Santa Fe , TRICARE Referral Specialist, Other , Santa Fe, New Mexico

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