Supervisor, Provider Ops

About the role

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.

Responsibilities

• 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.
• Captures and 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.

Requirements

• Required: Bachelor's degree with 2 years directly-related work experience or equivalent work experience
• If supporting TRICARE contract, must be a U.S. Citizen
• If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 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

Qualifications

• Preferred VA Program experience
• Excellent written and verbal communication skills

Skills

• Coaching / Training / Mentoring
• Communication / People Skills
• Computer Literacy
• Coping / Flexibility
• Empathy / Customer Service
• Independent Thinking / Self-Initiative
• Information Management
• Leadership
• Problem Solving / Analysis
• Technical Skills

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, 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

Pay

$67,000 - $71,000 per year

Schedule

Works within a standard office environment, with moderate travel