Healthcare Operations Specialist-CO, KS, MT, ND, NE, NM OK and TX

TriWest Healthcare Alliance Corp.; Houston (TX); On-site; USD 42,000 - 45,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

Paid time off

401(k) Retirement Savings Plan

Disability insurance

Tuition reimbursement

Paid volunteer time

Job summary

TriWest Healthcare Alliance Corp. seeks a Healthcare Operations Specialist to provide non-clinical support for healthcare operations, handling data entry and CRM workflows.

Responsibilities include coordinating with staff, handling calls, and driving process efficiencies in a virtual environment. The role requires US citizenship, 3+ years in medical administration, and proficiency with Microsoft Office and multiple IT systems.

Qualifications

• High School Diploma or GED required.
• U.S. Citizenship required.
• 3+ years of administrative experience in a medical office, health insurance, or managed care operations setting, or equivalent.
• Proficient with Microsoft Office suite.
• Proficient data entry skills and ability to effectively navigate multiple IT applications.
• Must be able to receive a favorable Interim and adjudicated final DoD background investigation.

Responsibilities

• Process tasks in medical management and CRM systems according to procedures.
• Assist with registration requests in various programs with supported staff.
• Handle inbound/outbound calls related to medical management programs and provider inquiries.
• Conduct outreach to obtain medical documentation and facilitate program registrations.
• Respond to beneficiary, provider, and staff requests using standard processes.
• Coordinate day-to-day activities with TW operations leadership.
• Maintain HIPAA privacy for PII/PHI and ensure compliance.
• Identify and resolve daily work blockers and issues.
• Foster cross-functional communication across teams.
• Work independently and in a team in a fast-paced environment.
• Regular and reliable attendance is required.

Skills

Data entry

Microsoft Office

CRM systems

HIPAA compliance

Multitasking

Attention to detail

Education

High School Diploma or GED

Tools

CRM systems

Microsoft Office

Job description

Profile

We offer remote work opportunities in the following locations ONLY: CO, KS, MT, NE, NM, OK, TX,

US Citizenship REQUIRED: Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen, and military family members are encouraged to apply!

Job Summary

The Healthcare Operations Specialist provides non-clinical support to TriWest healthcare operations teams, supporting the access to care our military community deserves. The Specialist regularly collaborates with TriWest (TW) staff, providers, beneficiaries, their families, and other team members to complete daily operational tasks. This work includes data entry and task processing in medical management and customer relationship management (CRM) systems, and making and receiving telephone calls, including participation in outreach campaigns. Along with ensuring accuracy and efficiency, this role requires significant attention to detail, the ability to prioritize and organize work, and regular assessment of current workflows to create efficiencies. Duties are primarily performed in a virtual work environment using collaboration tools and platforms.

Education & Experience

Required

• High School Diploma or G.E.D.
• U.S. Citizenship
• 3+ years of administrative experience in a medical office, health insurance, or managed care operations setting, or equivalent
• Proficient with Microsoft Office suite
• Proficient data entry skills and ability to effectively navigate multiple IT applications
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation

Preferred

• Medical Assistant (MA) or Certified Nursing Assistant (CNA)
• Knowledge of Medical Terminology
• Prior experience in a Managed Care Organization (MCO)
• Prior experience with TRICARE or VA health plans

Key Responsibilities

• Proactively evaluate and process assigned tasks within the medical management and CRM systems in accordance with desk procedures and defined rules.
• Manage and complete requests for registration in various programs in collaboration with supported staff (care management, enrollment, credentialing, etc.).
• Handle incoming and outgoing phone calls in an efficient and professional manner, including inbound phone queues for calls related to medical management programs and provider inquiries.
• Conduct telephone outreach to secure medical documentation and, within defined outreach campaigns, provide information and facilitate registration for medical management programs available to beneficiaries.
• Utilize standard program processes to respond to beneficiary, provider, and staff requests.
• Support the assigned TW operations leadership team by coordinating tasks and day-to-day activities, as requested.
• Take appropriate measures to comply with HIPAA regulations to protect the privacy of beneficiaries’ personally identifiable information (PII) and protected health information (PHI).
• Efficiently identify and resolve issues or address barriers to daily work.
• Foster cross-functional communication with other organizational teams and departments.
• Ability to work independently and collaboratively in a fast-paced environment.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

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, TEAMs, TriWest Intranet, the Internet, and department software applications.

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position. Respectful behavior when working with a diverse population and workforce.

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

Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, sometimes demanding environment.

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. Respectful behavior in a diverse environment and workforce.

Technical Skills: Working knowledge of the healthcare system and medical terminology. Knowledge of TRICARE programs and benefits, managed care programs or other government healthcare programs.

Working Conditions

• Extensive computer and telephone work with prolonged sitting
• Virtual team members and workflows
• Ability to do repetitive work and maintain production standards

Company Overview

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.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

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:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $42,000 - $45,000 per year.

Equal Employment Opportunity

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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.