We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA / DC, *WA, WI & WY only).

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

Supports beneficiaries by performing complex account administration and billing reconciliation for TRICARE Prime and TRICARE Reserve Select programs.

Applies advanced knowledge of DEERs Catastrophic Cap and Deductible and PGBA TMBS systems. Analyses and applies business rules appropriate to different categories of beneficiaries in a complex fee-structured environment.

Determines the effect of certain 'Qualifying Life Events' on the enrollment and billing structure of accounts.

Education & Experience

Required :

Bachelor's degree in Accounting, Healthcare Administration, or other business-related field or equivalent experience

U.S. Citizenship

Must be able to receive a favorable interim and adjudicated final Department of Defense background investigation

Experience in healthcare billing, Accounts Receivable, Auditing, or other Accounting-related discipline

Thorough knowledge of Accounts Receivable and Accounting principles

Preferred :

TRICARE payment processing knowledge and experience

Key Responsibilities

Researches beneficiary account billing records to reconstruct payment history and verify accurate fee statements are generated to the correct beneficiary address.

Utilizes advanced techniques and the research tools available from Defense On-line Enrollment System, PGBA TMBS system and Catatstophic Cap and Deductible System.

Researches and validates that payments are posted and applied to beneficiaries' accounts accurately, including correct paid-through dates for the appropriate fee schedule, bill type and enrollment eligibility dates for each period in the fiscal billing cycle.

Researches call center, Customer Service ART Requests, Military Treatment Facility requests for assistance and beneficiary requests reported through West Region Desktop Application to insure beneficiaries receive timely, accurate billing statements.

Assure correct posting of payments, correct application of fees applied per quarter and any overpayments or discrepancies.

Assist other departments (Call Centers / Accounting) to obtain proof of payment for reported fee discrepancies not applied to the account.

Modifies billing information in the PGBA TMBS billing systems and / or Defense On-line Enrollment system to reflect any changes to beneficiary status to appropriately disperse fund and ensure appropriate updates to other system.

Researches and reconciles beneficiary accounts from available reports and reconciles fees on Catastrophic Cap and Deductible system and PGBA TMBS billing systems.

Troubleshoots and assists with the implementation and updating of Allotment / EFT payments and Recurring Credit Card processes to resolve issues between the field, beneficiaries, and Accounting Department.

Updates fee schedule and fee adjustments as needed on PGBA TMBS systems and Defense On-Line Enrollment system. Investigates all fee discrepancies to resolution.

Troubleshoots and processes split enrollments to include coordinating allotment changes with TriWest Accounting Department and other TRICARE contractors.

Participates in cross-functional subcontractor and government sessions to continually improve the billing process.

Troubleshoots and processes reinstatements for beneficiaries disenrolled in error. Follows up to ensure previous claim payments are appropriately re-adjudicated.

Completes Fee Exception reports on beneficiary enrollment and related fee errors / warnings as identified by the DEERS and Wisconsin Physicians Serve systems.

Investigates and prepares refund requests.

Investigates and triggers notice to beneficiaries when insufficient payment of fees has been identified.

Performs other duties as assigned. Regular and reliable attendance is required.

Competencies

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

Coping / Flexibility : Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service : Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative : Critical thinkers with ability to focus on things which matter most to achieving outcomes;

Commitment to task to produce outcomes without direction and to find necessary resources.

Information Management : Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

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

Technical Skills : Thorough understanding of TRICARE policies and contract requirements related to Enrollment; Strong data entry skills

Working Conditions

Working Conditions :

Works within a standard office environment or approved remote set-up

Availability to cover any work shift

Ability to maintain set production standards in a repetitive work environment

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
• Generous 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
• Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents : $40,000- $50,000 depending on experience*

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 cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply.

Applicants are considered for positions 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.

Last updated : 2024-09-10