TRICARE Community Rep - Walter Reed, D.C.

JOB SUMMARY:


The TRICARE Community Representative is responsible for the conduct of all beneficiary and provider education activities and the civilian provider relations program in the assigned service area. Schedules, coordinates and delivers required education and training activities in both large and small group settings, and provides benefit counseling and other beneficiary services in the TRICARE Service Center (TSC). The Community Specialist is the Military Treatment Facility (MTF) Commander's primary point of contact for scheduling and conduct of all required marketing, education and briefing support delivered at the MTF. Associate works out of the TSC and reports to the Site Manager. The TRICARE Community Representative is the primary point of contact between HNFS and our TRICARE network.



ESSENTIAL DUTIES AND RESPONSIBILITES:

Civilian Provider Contracting, Education and Relations- Acts as primary point of contact between HNFS and our TRICARE network.

Establishes and maintains critical business and working relationships with key network providers to ensure quality health care is available to all beneficiaries.

Monitors adequacy of the TRICARE provider network, identifies gaps in coverage and recommends contracting solutions.

Conducts provider contract negotiations and provides contracting support services in conjunction with the Provider Services Department.
Establishes and executes on-site education and provider relations support for network and non-network physicians in the assigned area.

Conducts educational workshops and office visits providing support and assistance to providers in large group or one-on-one settings, assisting with benefit, claims and contracting activities as and when appropriate. At non-MTF locations, the strategic placement of this level associate reflects the need for greater maintenance of and service to the network in the service area, and the percentage of time dedicated to this function is 40%.

MTF Commander Marketing and Education Support- Works with MTF Executives and plans, develops and executes MTF commander marketing, education and customer service support plan including physician and administrative staff training, in-processing briefing and enrollment activity support, and general TRICARE briefing support.

Schedules and conducts all beneficiary TRICARE briefings in the assigned area. Also provides briefing support and marketing event planning and support to line commanders, military retiree offices and organizations, and other military base support organizations.

Fulfills MTF commander marketing, education and customer service support requirements including physician and administrative staff training, in-processing briefing and enrollment activity support, and general TRICARE briefing support. (At non-MTF locations, the percentage of time dedicated to this function is allocated to civilian provider education and relations activities.)

Beneficiary Education- Schedules and conducts all beneficiary TRICARE briefings in the assigned area. Also provides briefing support and marketing event planning and support to line commanders, military retiree offices and organizations, and other military base support organizations.

Beneficiary Support Services- Provides on-site benefit counseling, and claims and enrollment support services to walk-in customers in the TSC.

Administration- Schedules briefings, support events and appointments, and compiles reports related to marketing, education and provider relations activities.

Attends MTF planning meetings.

Develops and executes annual marketing and provider education budget for serviced area and MTF(s).

REQUIREMENTS


Education:


Associate's degree required; Bachelor's degree in a health related field preferred


Experience:Three to five years experience with beneficiary education, member services or provider relations and support Minimum two years experience working for a Managed Care Support Contractor Minimum two years experience in a position requiring delivery of presentations in both small and large group settings



Knowledge, Skills & Abilities:Thorough knowledge of TRICARE program, benefit structure and Military Health System Thorough understanding of TRICARE claims processing requirements and procedures Excellent written and verbal communication skills, including the ability to conduct presentations and conduct question and answer sessions with large groups Excellent interpersonal skills and ability to work effectively and independently Must have valid driver's license, reliable personal transportation and ability to travel and work occasional evenings and weekends supporting educational events



OR


Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.



As a government contractor, this position requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P or higher security.



Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.

Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.