Supervisor, Provider Ops at TriWest Healthcare Alliance in Phoenix, Arizona

Job Description:

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

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)

Job Summary

Supervises the provider data management, credentialing or contract support teams to ensure that the department is meeting established goals and performance metrics. Oversees the processing of provider contract, demographic, and reimbursement information. Researches, verifies, and resolves provider data correction and/or contract requests. Monitors quality indicators, dashboard metrics, and operational/data analysis. Coordinates consistent follow-up processes to ensure TriWest data bases have current, accurate, and timely provider information. Communicates with internal and external customers to resolve provider data or contract issues and errors. Supervises daily operations of the respective team activities for TriWest. Maintains compliance with all regulatory guidelines. Models highest level of customer service. Manages staff work flow and maintains provider files, contracts and credentialing documentation in compliance with VA and URAC standards. Advises, trains, and coaches staff. Ensures staff desk procedures are up-to-date.

Education & Experience

Required:

• Bachelor's degree with 2 years directly-related work experience or equivalent work experience
• Working knowledge of the credentialing process and regulatory compliance such as URAC and JCAHO or the contract support function
• 2 years supervisory experience or leadership skills
• Demonstrated ability to function under minimal supervision and make independent judgments

Preferred:

• VA Program experience
• Excellent written and verbal communication skills

Key Responsibilities

• For the provider data supervisor, coordinates Provider Data Management and provider data correction requests, including: managing department workflow and workload; developing and tracking provider data quality metrics and reports; developing and managing the provider data quality dashboard used to notify network subcontractors and TriWest of their compliance with established metrics; monitoring the entire provider data process to identify anomalies or issues that should be addressed; and maintaining audit plans.
• Supervises daily operations and staff for all respective functions. This includes maintenance and annual review of the policies and procedures.
• Assists in the development and implementation of audit plans to include on-site audits at TriWest and each network subcontractor.
• Coordinates with Data Management on reporting requirements and coordination with related Provider functions.
• Ensures that provider data is compliant with established data entry policies and procedures when entered into the Visual CACTUS database for direct contracted states, Veteran's Administration, and corporate contracts.

• Functions as a central Point-of-Contact within TriWest for respective customers and partners.
• Provides support for URAC Health Network accreditation.
• Ensures department's compliance with established policies and procedures as well as all applicable.
• Continually examines the department procedures to identify opportunities for process improvement, using existing or new technology, as resources are available.
• Facilitates staff training, support, and development including: ensuring that staff is fully-informed through regular staff meetings; establishing and maintaining staff performance standards; addressing staffing and performance issues; performing monthly one-on-ones with each staff member; and providing performance feedback to staff and conducting performance evaluations.
• Attends meetings or functions outside of normal business hours.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.

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

Technical Skills: Thorough knowledge and complete understanding of the credentialing process and requirements; proficient with Word, Excel, Visual Cactus 3.0, credentialing software, and the ability to produce reports through querying; working knowledge of the VA policies and procedures outlined in the VA Operations manual, VA Policy Manual, DoD Regulations, and the TriWest Central Region RFP.

Working Conditions

Working Conditions:

• Availability to cover any work shift
• Works within a standard office environment, with moderate travel
• Extensive computer work with prolonged 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.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

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 and Washington State residents: $59,000 - $65,000 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.