Manager, Provider Data

Manager, Provider Data at TriWest Healthcare Alliance Manager, Provider Data at TriWest Healthcare Alliance in Cheyenne, Wyoming Posted in about 19 hours ago.

Type:

Full-Time Job Description:

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only) Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Manages Provider Data operations to ensure that the department is meeting established goals and performance metrics. Oversees the processing of provider contracts, demographic, and reimbursement information. Researches, verifies, and resolves provider data correction requests. Monitors provider data quality indicators, network subcontractor dashboard metrics, and operational/data analysis. Coordinates consistent follow-up processes to ensure TriWest data bases have current, accurate, and timely provider data information. Leads the communication with internal and external customers to resolve provider data issues and errors.

Education & Experience Required:

• Bachelor's degree in Healthcare Administration or related field or equivalent experience
• 3+ years provider data experience in a leadership role
• 3+provider data management systems experience
• Experience in training, planning, leading, and participating in major process improvement projects

Preferred:

• Federal Program Experience
• Subcontract management experience
• Excellent written and verbal communication skills Key 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 maintains audit plans.

• Oversees the daily operations and staff for all credentialing and re-credentialing functions in those states that have direct contracts, as well as corporate contracts. This includes maintenance and annual review of the credentialing policies and procedures.
• Assists in the development and implementation of a credentialing audit plan to include on-site audits at Tri-West and each network subcontractor.
• Ensures that provider data is compliant with established data entry policies and procedures, functions as a central Point-of-Contact within TriWest and for each network subcontractor regarding credentialing-related questions and operations.
• Ensures department's compliance with established policies and procedures.
• Continually examines the department procedures to identify opportunities for process improvement, using existing or new technology, as resources are available.
• Provides 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.
• Manages daily operational resources, tracking results against requirements.
• Participates in special projects and meetings.
• Attends meetings or functions outside of normal business hours.
• Performs other duties as assigned.
• 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

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 Multi-Tasking /

Time Management:

Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment

Organizational Skills:

Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented Team-Building /

Team Player:

Influence the actions and opinions of others in a positive direction and build group commitment

Technical Skills:

Working knowledge of URAC standards and State and Federal Regulations; Current knowledge of primary source credentialing, credentialing processes, systems and data collection, URAC, Veteran Affairs, JCAHO and NCQA credentialing standards, and medical terminology; Knowledge of credentialing and data management systems; Proficient with Word, Excel, PowerPoint; or other applications

Working Conditions Working Conditions:

• Availability to cover any work shift
• Works within a standard office environment, travel may be required
• Extensive computer work with prolonged sitting
• Must be able to obtain appropriate DITSCAP security clearance 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 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 TriWest job postings typically include a salary range, which can vary based on the specific role and location , but generally this position ranges from around $92,000 - $107,000 per year. 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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.