Jerome Thinner

Served as key on-site/remote point of contact for three Prime Service Areas (Fort Leonard Wood, MO; 509th Medical Group, Whiteman AFB, MO and 28 Medical Group, Ellsworth AFB, SD) MTF staff regarding all issues regarding any of possible issues relating to enrollment, referrals and authorization

• To include issues with network providers, and any other related matters
• Utilized HNFS customer service tool to identify and distribute all issues to appropriate HNFS corporate division for follow-up and resolution
• Urgent matters were handled same day by telephone, e-mail or MSTeams with applicable subject matter expert (SME) or supervisor
• Monitored issues that were referred to by MTF staff and intra-organizational areas for trends or opportunities to improve HNFS services and identified root causes and work with MTF staff to develop possible courses of action and implementation of corrective actions
• Reviewed and facilitated resolutions of referral and authorization issues and trends, analyzed each issue for possible root cause and train MTF staff or civilian network providers on appropriate actions for submitting referrals using MHS Genesis or Care Affiliate
• Provided Tricare informational/education briefings for meetings with MTF staff, civilian network providers, beneficiary groups and provided expert explanations of various Tricare health plans
• Provided on-site and virtual outreach activities for military installation communities such as Deploying and Redeploying Service Members and their Family Members, Family Readiness Groups, Retiree Associations; Installation Newcomers Orientation with such matters transferring enrollments, PCM changes, and other areas for new arrivals
• Documented and recorded performance of educational briefing provided for input to contract performance reporting in accordance with HNFS policy and procedures
• Conducted monthly meetings with MTF staff to identify and develop opportunities to increase contractual performance measures while simultaneously improving MTF optimization in support of Defense Health Agency (DHA) Network goals
• Instrumental in assisting MTF, Regional Director and local community partners with contingency planning for MTF contingency exercises or actual contingency situations in support if MTF and HNFS network partners
• Maintain up to knowledge of the Managed Care Support Contract; changes to the Tricare Operations Manuel and HNFS policies and procedures applicable to the success of the organization
• Contribute to achieving the network discount goal that results in annual financial incentives awarded by the Government.

• Served as the Provider Relation Representative II for Fort Leonard Wood, MO and the 509th Medical Group, Whiteman AFB, MO Prime Service Areas
• Initiated and maintained effective channels of communication with service providers and clients to educate and provide updates to the Tricare program. Gathered, reviewed and verifying all pertinent information relating to participating healthcare providers requesting to become part of the HNFS network and non-network directory
• Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service
• Conducting training of service providers on policies, procedures, service lines, and available technology
• Answering questions from doctors' offices on benefits
• Collected, reviewed, and submitted relevant documentation needed for claims processing
• Managed healthcare provider accounts to maximize company strategies and goals
• Maintained a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare
• Assisting help desk staff with more complicated benefit queries received
• Identifying shortfalls in healthcare provision and initiating improvement opportunities.
• Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
• Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.

• Served as Beneficiary Counseling and Assistance Coordinator and Debt Collection Assistance Officer for General Leonard Wood Army Community Hospital
• The BCAC’s main job is to assist beneficiaries to understand and access their Tricare benefits and services to meet their healthcare needs
• As BCAC I educated Service Members and their families on TRICARE plan during a qualifying life event or as a significant change in their healthcare
• I interacted with other hospital staff members, regional contractors, and claims processors to help resolve beneficiary's concerns, as well
• As DCAO, I assisted with claims and billing resolution, and debt assistance
• I would work with the beneficiary, network providers and PGBA for claim resolutions by providing proper form and expectation management
• As a BCAC I addressed, eligibility, enrollment, referral/prior authorization, covered services, the Nurse Advice Line and receiving care at the local military treatment facility.