TriWest Site Lead

Maryland Heights MO 63043 St Louis 1 14100 Magellan Plaza

Job Description

- Monitor on-site attendance, review timesheets and approve timesheets for 20-40 staff members to ensure regular and reliable attendance and accurate timekeeping
- Support the Program Manager in execution of his or her supervisory and quality assurance functions to include alerting the Program Manager of concerns about the performance of duties by members on staff
- Coordinate and attend both all-hands and individual meetings held by the Program Manager during site visits
- Disseminate changes in client policies or procedures to staff, both orally and in writing while ensuring all staff members are aware of updates
- When directed, provide 1:1 instructions to staff on client policies or procedures to include appropriate documentation in the case management system

o Review and respond to complex referral requests from VA and civilian providers with appropriate coding and provider selection.
o Researches and contacts the VA POC for essential missing information that cannot be located in the TriWest medical management system.
o Enters referral requests into the medical management system with appropriate coding and provider selection.
o 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.
o Answers inbound calls from Veterans and providers in a timely manner
o Consistently displays professional and courteous service skills to internal and external customers.
o 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.
o Contacts network providers to schedule, reschedule or cancel Veterans’ appointments.

o Works with standard coding systems including: standard medical taxonomy, International Classification for Diseases, Current Procedural Terminology, and Health Care Common Procedure Coding System.
o Demonstrates proficiency with the medical management system for tracking and updating medical documentation from the network providers for every patient encounter.
o 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.
o Takes appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries' health information.
o Tracks, receives, reviews medical information for completeness in accordance with VA and TriWest requirements.

o Documents every aspect of appointing, patient transfers, inquiries or complaints thoroughly in the medical management system.
o Documents all communications involving Veteran and provider contacts.
o Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialist and other departments
o Receives and reviews faxed documents to ensure appropriate entry into the medical management system.
o Understands and utilizes the grievances and appeals process available to dissatisfied beneficiaries and providers.
o Identifies potential discrepancies in the medical management system to assure quality program compliance.
o Consistently meets department productivity and performance metrics.
o Performs other duties as assigned.
o Regular and reliable attendance is required

General Job Information


TriWest Site Lead



Job Family

Customer Service Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Customer Service, Management/Leadership


A Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


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

o More than two years experience working in a call center and or/medical appointing in a medical office
College coursework in healthcare or equivalent field

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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