TRICARE Clinical Administrative Coordinator – Phoenix, AZ

Job Listing No: 9740000

TRICARE Clinical Administrative Coordinator – Phoenix, AZ

Details: Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work. Our Customer Service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care.This position works under the direction of the Clinical Quality Management (CQM) Medical Records Manager. The Medical Records Clerk processes requests for medical records for potential quality issues, studies, TRICARE Quality Monitoring Contractor (TQMC) requests, and other activities involving medical records. Maintains compliance with TRICARE requirements. Maintains confidentiality of all quality assurance activities and protects all personal health information (PHI) in accordance with all rules and regulations. Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles. As a potential government contractor, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF85P. Primary Responsibilities: Process requests for medical records. Mail or fax requests for medical records to facilities and providers within process timelines. Calls facilities and providers for status of requested documents. Document and track status of all medical record requests in medical records database. Files and maintains received medical records and CQM documents per file plan. Processes mail received in the CQM department. Prepare and transfer medical records to the TQMC to meet contract delivery timeline requirements. Processes invoices for received medical records. Maintains and ensures the organization of the medical records room. Archives records when appropriate and per policies and procedures. Assists clinical staff with the assembly of case files. Performs all other duties as assigned. Moderate work experience within own function. Some work is completed without established procedures. Basic tasks are completed without review by others. Supervision/guidance is required for higher-level tasks.

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