Location: Phoenix, AZ

Reviews and enters complex authorizations and referrals from VA and providers. Ability to effectively communicate medical information, test results, diagnoses and or proposed treatment in a manner easily understood by the patient. Must be able to effectively communicate with clinical staff. Ensures accurate data entry and completion of authorization data from customer information, medical records, referral/authorization forms, assists Patient Service Representatives (PSRs) in obtaining consult reports within required turnaround times. Provides initial data entry related to potential quality issues. Under the direction of a supervisor, requests appropriate records and process initial review of those records. Works in a fast-paced production environment.

• Conducts research to ensure accurate documentation of the patient's clinical information.
• Review and respond to complex referral requests from VA and civilian providers with appropriate coding and provider selection.
• Responds to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes referrals, authorizations, and the location and use of network and certified providers.
• Consistently display professional and courteous service skills to internal and external customers.
• Takes appropriate measures to comply with HIPAA regulations to protect privacy of Veteran’s health information.
• Documents the transmission of medical referrals to the facility or the network provider in line with procedures.
• Documents all communications involving Veteran and provider contacts.
• Develops knowledge of various software applications in use at TriWest, including procedures and processes of the VA program.
• Assesses faxed or emailed documents, to ensure appropriate entry into the medical management system.
• Works with standard coding systems including: standard medical taxonomy, International Classification for Diseases, Current Procedural Terminology, and Health Care Common Procedure Coding System.
• Verifies and ensures that appropriate referral procedures are followed for the various types of VA eligible beneficiaries. Ensures procedures are followed for referrals based on Veteran category geographical location and the provider's request.
• Enters data into the medical management system.
• Identifies potential quality of care or safety issues
• Requests medical records as directed, scans records into the medical management system, and prepares records for quality of care review.
• Identifies potential discrepancies in the medical management system to assure quality compliance.
• Consistently meet department productivity and performance metrics.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Required

• High School diploma or G.E.D.
• At least one full year experience in a medical office or health care environment, which includes data entering medical records or information
• Knowledge of medical terminology normally obtained through a medical certification OR experience using, interpreting and applying ICD and CPT code
• Experience using Microsoft Office, the Internet and medical/health systems

Preferred

• College course working in the healthcare or equivalent field