product support California
Job description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Serve as a primary on-site referral/authorization (R/A) point of contact to Military Treatment Facilities (MTF) and Markets. Research and respond appropriately and timely to inquiries from MTF customers. Closely monitor delivery of customer service and support and resolving local R/A problems, issues and concerns. Recommend and implement strategies for resolving issues and improving service quality and timeliness. Process certain referral requests to completion. Educates MTF staff and network providers on submission of Referrals and Authorizations. Maintains database of local network providers on their access to care, preferred providers, and discount rates to leverage when processing.
Acts as the point of contact to military personnel at designated Military Treatment Facilities for referral submissions and processing to ensure local provider is available to treat and the beneficiary.
Serves as the subject matter expert for the identification of local network access to care, preferred providers, provider capabilities, and discount rates to leverage for accurate referral submissions.
Responsible for completing a cross-functional response for resolution of questions or referral issues during the authorization process. Identify and communicate any trends related to referral problems to OIM management, which also includes partnering with the local TRICARE Liaison to address systemic or local referral issues through early identification.
Educates providers on HNFS and TRICARE policies and procedures related to referrals and web services when impacting a beneficiary’s immediate access to care. Also provide consultation to providers regarding TRICARE clear and legible report submission requirements.
Conduct regular, proactive outreach to local healthcare community to maintain record of current access to care, wait times, and provider capabilities.
Education/Experience: Associate’s degree or equivalent experience required. Bachelor’s preferred. Minimum of 2 years of experience working in association with, or for, a DoD Managed Care Support Contractor (TRICARE), Medicare/Medicaid Program, Commercial Healthcare Plan or Healthcare Provider/Group. Functional understanding of how any/all of the above healthcare programs work and their coordinator of benefits. Experience in customer relations, referral processing, and/or the TRICARE program preferred. Government Security/Clearance/Citizenship Requirements. Licensure/Certifications: Requires security clearance, CAC/NAC
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Pay Range: $21.93 - $37.30 per hour
Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
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.
