Job Description:

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only).

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

Ensures accurate, timely maintenance and synchronization of critical credentialing and provider data on all provider databases and systems, including the credentialing system. Accesses and utilizes multiple software applications. Applies business rules and knowledge of provider contract language, pricing and reimbursement methodologies to each database/system in order to validate provider information in all systems. Functions as a lead liaison with customers. Communicates with internal and external customers by phone and email to address provider credentialing and data questions, as well as follow-up on issues. Work meets established timeline, accuracy and production targets. Able to manage large amounts of complex information, communicate it clearly, and draw sound conclusions.

Education & Experience

Required:

• High School Diploma or G.E.D.
• 2 years of experience with healthcare/managed care programs or provider relations
• 2 years of credentialing experience

Preferred:

• 3 years of experience with healthcare/managed care programs or provider relations
• 1 year team lead experience

Key Responsibilities

• Coordinates distribution of team workload for assigned workflows and state responsibilities, which includes processing imported data files and manual data entry.
• Acts as the first line resource for staff to provide guidance and direction in resolving provider data, credentialing or system issues.
• Functions as a lead liaison with network subcontractors and internal staff regarding provider data, credentialing and system issues, which includes regularly scheduled meetings to discuss discrepancies and handles non-routine provider data and credentialing issues.
• Ensures accurate and timely processing and maintenance of provider data and credentialing in multiple database systems.
• Analyzes provider data received via electronic import files to determine appropriate handling to ensure data is synchronized within all systems. Identifies gaps or issues with provider data by running reports and querying provider databases on a regular basis to resolve issues timely and accurately.
• Ensures timely and accurate credentialing of individual and institutional providers by utilizing desk procedures and working directly with the Provider Services leadership team.

• Runs reports using the credentialing system and responds to inquiries regarding credentialing compliance issues and general questions on technical aspects of credentialing policies.
• Drafts new and/or updates existing department policies and desk procedures/workflows by utilizing knowledge and familiarity with processes.
• Maintains working knowledge of URAC credentialing standards.
• Works on special projects, researches issues, and performs other duties as assigned.
• Regular and reliable attendance is required.

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Competencies

Commitment to Task: Ability to conform to established policies and procedures; exhibits high motivation.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapts to different styles; collaborative; listens attentively.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, Excel, Teams, TriWest Intranet, and departmental software applications/systems.

Organizational Skills: Ability to organize people or tasks, adjusts to priorities and learn systems within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment and critical thinking skills; has a thorough understanding of relevant issues.

Technical Skills: Proficient with Word, Excel, provider databases, credentialing systems; able to produce reports through querying; working knowledge of VA requirements outlined in the VA Operational and Policy Manuals; working knowledge of Department of Defense (DoD) TRICARE regulations outlined in the TRICARE Operations and Policy Manuals; working knowledge of URAC credentialing standards; Managed Care or healthcare experience.

Working Conditions

Working Conditions:

• Availability to cover any work shift
• Works within a standard office environment with minimal travel
• Extensive computer work with prolonged periods of sitting

Company Overview

Taking Care of Our Nation's Heroes.

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.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage


• Generous paid time off


• 401(k) Retirement Savings Plan (with matching)


• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance


• Tuition reimbursement


• Paid volunteer time

*Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $45,000-$52,000 depending on experience*

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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