Job Description

We offer remote work opportunities (AK, AZ, HI, ID, NV, NM, OR, TX, UT, VA, WA and WY only) The PCRS reviews incoming provider complaints/grievances, priority inquiries and VA escalations associated with network providers within the VA Patient-Centered Community Care (VAPC3) and Veterans Choice programs; researches and compiles facts associated with the inquiry or complaint/grievance ; refers issues to appropriate subject matter experts and/or operations staff for appropriate action/response/resolution ; tracks ongoing research, resolution and/or refinement of responses received; develops written responses (when required) to address provider complaints/grievances and other priority inquiries and/or confirms closure of issue and education/resolution with provider; follows-up to ensure that systemic issues, processing errors and staff, provider office representative or program user education gaps are addressed; interfaces both orally and in writing with p provider office staff and internal TriWest staff. Education & Experience Required: • Associate degree in political science, communications, business management or equivalent experience. • Experience in investigating and/or responding to complaints • Strong verbal and written communication skills • Strong working knowledge of MS Word, Excel and Outlook Preferred: • Experience in the health care industry and/or constituent services (state or federal) • A solid understanding of the Health Insurance Portability and Accountability Act (HIPAA), related privacy laws and security measures (physical storage, open discussions and electronic transmissions) for safeguarding Protected Health Information (PHI) and Personally Identifiable Information (PII). • Experience working with Government agencies and/or VA Health Care System Key Responsibilities • Reviews incoming complaint/grievance submissions directly from providers or triaged from Customer Service as well as priority inquiries to determine the most appropriate and effective course of action. • Conducts thorough research and analysis of targeted issues by accessing multiple TriWest online systems and interfacing with TriWest staff in all functional areas regarding the services provided under TriWest's VAPC3 and VCP contract. • Coordinates with and communicates with various TriWest departments, subcontractors, and providers as needed to obtain information required for substantive/quality responses to complaint/grievance submissions and priority inquiries. Reviews departmental responses to complaint/grievance submissions and priority inquiries to ensure that responses appropriately address the concerns expressed in the inquiry by the Veteran. • Helps prepare written responses to inquiries (if needed) and coordinates all input into planned response prior to managerial review. • Documents communications with provider office staff members and VA stakeholders. • Creates and maintains records and files on individual complaints/grievances and priority inquiry casework. Tracks all casework referred to/from TriWest departments or subcontractors to ensure that all casework has documented outcomes for timely resolution. Prepares and files casework. • Maintains logs and other tracking tools to assist department leadership with reporting and leadership decision-making requirements. • Identifies and reports potential fraud or patient quality issues to the appropriate department. • Perform other duties as assigned. • Regular and reliable attendance is required. Company Description Taking Care of Our Nation's Veterans. 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.

Company Description

Taking Care of Our Nation’s Veterans. \r\nIt’s Who We Are. It’s What We Do.\r\nDo you have a passion for serving those who served? \r\n \r\nJoin the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!\r\n \r\nOur job is to make sure that America’s heroes get connected to health care in the community. \r\n \r\nAt TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.