Angestellte/r Patientenmanagement Wiesbaden, Germany Ausschreibungsbereich WHO MAY APPLY? Current INTERNAL Local National Employees throughout Germany. This covers all current Local National employees of the U.S. Forces in Germany, including U.S. Army & Air Force Exchange Service (AAFES)-Europe within Germany And EXTERNAL Local National Applicants, who reside in Germany. Hauptaufgaben Serves in the capacity of Consult Manager. Processes requests for medical care and services which cannot be provided by the Military Treatment Facility (MTF). Ensures the accurate and timely processing of referrals to the network for all active duty, dependent, and retiree's needs. Requires proper interpretation of applicable rules and regulations of the Defense Eligibility Enrollment Reporting System (DEERS), TRICARE policy, DA MEDCOM policies and publications on Managed Care and the Supplemental Health Care Program, and broad general DoD guidelines. Determines applicable options regarding all supplemental care requests. Counsels patients concerning reasons for the sources selected, the extent of Government financial liability, cost-sharing provisions when TRICARE is involved, available alternatives, forms and documents required, and payment procedures. Coordinates patient arrangements and serves as liaison between civilian providers, the MTF, and the managed care support contractor on administrative matters related to the referral process. Provides advice as to the appropriateness of utilizing supplemental care in questionable cases. Tracks medical consults deferred to the network and resolves issues related to consult process. Facilitates medical care of Military Health System (MHS) beneficiaries and the Joint Commission requirements for consult and referral tracking. Exercises authority to oversee the timely execution of consult management to include tracking, documentation, and retrieval of the consultation reports and transmittal of the same to both the referring provider and the patient's medical records. Utilizes DoD enterprise software, Composite Health Care System (CHCS), Armed Forces Health Longitudinal Technology Application (AHLTA), Health Artifact and Image Management Solution (HAIMS), Defense Travel System (DTS), Managed Care Support Contractor (MCSC) web based platforms and commercial software including but not limited to Microsoft Office and Adobe Pro to perform daily referral functions. Utilizes knowledge of medical terminology, medical specialty areas, and specialized medical tests, and utilization of Milliman Care Guidelines in the determination of proper consultation disposition and benefit consideration. A qualified typist is required. Collects, consolidates, and monitors a wide range of supplemental health care data. Tracks all Active Duty (AD) referrals daily and verifies authorizations have been approved. If the Service Members are Warrior Transition Unit (WTU), Initial Entry Training (IET) or other enhanced access category, the Case Manager is notified of authorization status and provider/service to contact for scheduling appointment. Upon completion of authorization for AD to a Durable Medical Equipment (DME) company, all forms and required documents are faxed to the appropriate agency. Monitors incoming Managed Care Support Contractor (MCSC) faxes and web based or enterprise software programs daily to identify any referral in a pending status or with conflicting information. Performs investigation of the situation to resolve issues and expedite completion for authorization. Documents in RWBAHC Web systems database on processing/research of each deferred AD referral and status. Files completed cases daily. Tracks and assists with AD Out of Area Care (OAC) and adjudicating payment of TRICARE allowable benefits based on DoD guidelines. Processes MTF associated bills for payment with supplemental care funds and/or Prime Travel benefit funds. Ensures bills received are appropriate for payment using Supplemental Health Care Funds (SHCF) or PT benefits funds and have been submitted with appropriate Current Procedural Terminology (CPT) coding, and other supporting documentation. Applies appropriate TRICARE/Champus Maximum Allowable Charge (CMAC) and any negotiated rates to bills to TRICARE Fiscal Intermediary for Diagnosis Related Group (DRG) coding/costing. Prepares supplemental care and travel vouchers for payment, adds correct accounting data, and forwards documentation for fund certification. Researches billing discrepancies and resolves problems when possible. Provides expert guidance to MHS beneficiaries on the eligibility and qualification requirements for processing of PT claims. Utilizes Defense Travel System (DTS) to assist travelers not issued a common access card (CAC) under the TRICARE prime travel program for medical travel reimbursement as T-Entry agent. Performs other duties as assigned. Qualifikationsanforderungen Explanations to the E&T Levels (Education & Training Levels) can be found at the following link: https://portal.chra.army.mil/mnrs?sys_id0a86e971cd2d2d10aaffb5ebb50f5ac9&viewsp&idmnrs_kb_article&tablekb_knowledge C-5a: E&T Level I: 2 years of creditable experience as defined in A below PLUS 2 years of experience as defined in B below. Current employees who do not meet E&T Level I and who are not in the same or similar occupation must have 2 additional years of creditable experience as described in A below. E&T Level II: 1 years of creditable experience as defined in A below PLUS 2 years of experience as defined in B below. E&T Level III: 1 year of experience as defined in B below. E&T Level IV: No additional experience required. Current employees who have served one year in the same or similar occupation are qualified for the next higher grade. Experience A: Included clerical work in an office or store, working with computers, bookkeeping, making and recording inventories, telephone marketing, arranging for events or as a cashier, etc. Experience B: Experience in the same or similar line of work as the job for which considered. The experience must demonstrate that the applicant possesses the particular knowledge, skills and abilities required in the position. The predominant experience must have been gained at a comparable level of difficulty to the position to be filled. The amount of the higher level experience must be in a reasonable relation to the required total number of years. Auswahlkriterien auswählen LANGUAGE PROFICIENCY LEVEL: English AND German Language Proficiency Level B2 required. You may test yourself for free at one of the various online providers, who offer tests under the 'Common European Framework of Reference for Languages' (CEFR). B2 Understand the main ideas of a complex text such as a technical piece related to their field. Spontaneously interact without too much strain for either the learner or the native speaker. Produce a detailed text on a wide range of subjects. Description of the Language Levels: https://portal.chra.army.mil/mnrs?sys_id13a66d71cd2d2d10aaffb5ebb50f5aa0&viewsp&idmnrs_kb_article&tablekb_knowledge Experience with the use of common software and computer systems, carrying out routine office work ( Office Automation) is required. Knowledge of Basic Medical Terminology required Beschäftigungsbedingungen These are two permanent full-time positions (38.5 hours/ week). Relocation expenses are not authorized. THIS CONCERNS ALL EXTERNAL APPLICANTS: Generally, you must have been a resident in Germany for at least 12 months. Non-US citizen family members and German citizens are exempt from this requirement. Your permanent residence must be within Germany. Police Good Conduct Certificate (Polizeiliches Führungszeugnis): On initial appointment, or re-appointment after a break in service, candidates who have been selected for a position must present a police good-conduct certificate prior to appointment to the position. The applicant must obtain the certificate from the local resident registration office. The cost for the certificate is not reimbursable. Non-U.S. citizen family members, except German citizens are exempt from this requirement. Upon appointment with the U.S. Forces it is required to present two valid picture identifications to get access to the computer systems. Recognized documents are only: Personal ID (Personalausweis), Personal Travel Identification (Reisepass) and the European Union (EU) Driver's License (plastic card format). We recommend ensuring at the time of application that at least two of these documents are available or requested. Foreign National Screening (Sicherheitsüberprüfung): In accordance with U.S. Army Europe Regulation 604-1, within three days after appointment, a background check will be initiated to determine suitability for continued employment with the U. S. Forces in Germany. If results are unacceptable, employment will be terminated during the probationary period, or any time thereafter, if the background checks reveal that the employee constitutes a security risk. Foreign education may be accredited, please refer to the following websites for additional information: www.anabin.kmk.org or www.anerkennung-in-deutschland.de