What are the responsibilities and job description for the Manager, Enrollment Fees position at TriWest Healthcare Alliance?
Directs the Enrollment operations and staff dealing with the billing and accounting of beneficiary fees, ensuring compliance with TriWest and TRICARE policies and production standards. Coordinates Enrollment initiatives in collaboration with Defense Health Agency (DHA), TriWest’s subcontract partner, and Defense Enrollment Eligibility Reporting System on integration matters as needed. Manages support staff and keeps in compliance with staffing budget.
Education & Experience
Required:
- Bachelor's degree in Business, Communications or related field or equivalent
- 5 years’ experience in healthcare claims processing, premium billing, or software applications in enrollment or healthcare system
- 3 years supervisory / leadership experience
- TRICARE knowledge; including knowledge of enrollment processes and systems such as DEERS and Beneficiary Web Enrollment
Key Responsibilities
Directs Fees & Administration operations and staff to achieve departmental goals. Develops and implements process improvements to enhance production standards, practices, and procedures. Ensures that Enrollment Billing and Accounting operations are consistent with defined procedures and comply with TRICARE and government requirements.- Supervises, coaches, trains, and develops staff. Coordinates work schedules. Ensures that staff is fully-informed of TRICARE fundamentals and contractual changes. Develops annual employee performance reviews and developmental plans.
- Sponsors, manages and participates on special projects with cross-functional work groups including senior leadership from TriWest, TriWest’s subcontract partner, Defense Health Agency (DHA) and other applicable TRICARE departments.
- Receives complex reinstatement requests and reviews reinstatements for appropriateness. Collaborates with DHA to obtain their approval prior to reinstatement when necessary.
- Ensures that billing statements are audited for accuracy using statistically-valid sampling techniques.
Coordinates and oversees system changes in operational processes, including new technologies. Maintains project plans and testing documentation for all Enrollment-related applications, including TriWest, government and subcontractor systems.- Represents Enrollment leadership at meetings as necessary for the Director, Enrollment.
- Oversees Enrollment correspondence to beneficiaries to ensure timely and effective resolution of fee concerns. Personally handles resolution of difficult Enrollment fee issues.
- Coordinates customer service efforts to resolve complex enrollment issues with other TriWest departments and external entities, including TriWest’s subcontract partners, TRICARE Service Centers, TRICARE Customer Assistance Centers, Wisconsin Physicians Service, Congressional and Customer Relations, Health Care Services, Contract Compliance Management, Claims, and Provider Services Management.
- Ensures complete and prompt resolution to any issues requiring Enrollment intervention. Collaborates with others to execute resolution, including TriWest department management and Field Operations, Service Area Directors, TRICARE Regional Office-West, Health Benefit Advisors, Office Managers and TRICARE Service Center managers.
- Develops and tracks metrics to measure effectiveness and efficiency of Enrollment operations for process improvement.
- Monitors Enrollment Fees & Administration outcomes, including fees, billing and accounting, documentation, and beneficiary fees inquiries.
- Ensures department desk procedures are up-to-date and accurate.
- Participates in projects, cross-functional teams, cross-functional meeting, and conferences as required.
- Updates Enrollment Director on personnel issues, system issues or process issues that impact workload.
- Works overtime as needed.
- 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.
Creativity / Innovation: Ability to develop unique and novel solutions to problems; view change as necessary.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.
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.
Technical Skills: Thorough knowledge of performance measurement tools and process improvement techniques; knowledge of information systems used for billing and accounting; working knowledge of TRICARE program; ability to analyze, apply, interpret and communicate policy, procedures and regulations; proficient in Microsoft Project, Word, Excel, PowerPoint, Access, and Visio; strong collaboration skills for cross-functional issues.
Working Conditions
Working Conditions:
- Works non-regular hours as necessary
- Works within a standard office environment, with 25% travel
- Department of Defense background security clearance required
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.
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
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.
