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Job Opening details:-
Company Name :- Federal Services
Position Name :-
Company Location :- Colorado Springs, CO
Job Category :- Jobs in general
Full Job Description :-
You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
The TRICARE Referral Specialist I supports and/or performs the referral/authorization processing function for the assigned Military Treatment Facility (MTF). Ensures completeness, accuracy & timely processing of select referral requests received from the MTF within contractual standards. Identifies incomplete or inaccurate referral requests and returns referral for correction to MTF point of contact. Serves as primary point of contact to the MTF for referrals to the appropriate, cost effective, purchased care source.
Process referrals from designated MTFs, ensuring they are assigned to provider able to see beneficiary
Research and respond appropriately and timely to inquiries from MTF/Market
Identify and communicate any trends in referral issues to OIM Management Coordinate with local TRICARE Liaison to address systemic and/or local issues through early identification
Coordinate with local TRICARE Liaison to address systemic and/or local issues through early identification
Maintain knowledge of local network access to care, preferred providers, and discount rates to leverage when processing referrals
Our Comprehensive Benefits Package:
Flexible work solutions including hybrid work schedules and dress flexibility
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and development
High School Diploma or GED Required; 3 years of Healthcare Industry experience. Referral processing and/or TRICARE experience, plus Medical terminology and CPT code knowledge preferred.
Licensure/Certifications: Requires security clearance, CAC/NAC
This 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.
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