Credentialing Quality Coordinator

TriWest Healthcare Alliance in; Phoenix (AZ); Remote; USD 52,000 - 66,000; Full time

Job summary

Join a dedicated team committed to serving America's heroes! In this remote role as a Credentialing Quality Coordinator, you'll support the Data & Credentialing Manager by conducting audits, reviewing policies, and ensuring the integrity of credentialing files. With a focus on quality and compliance, you'll play a vital role in enhancing credentialing processes and standards. This position offers a chance to make a significant impact in the healthcare sector while enjoying a comprehensive benefits package, including medical coverage and tuition reimbursement. If you're passionate about serving those who served, this opportunity is for you!

Benefits

Medical, Dental, and Vision Coverage

Paid Time Off

401(k) with matching

Disability and Life Insurance

Tuition Reimbursement

Paid Volunteer Time

Qualifications

• 2 years of credentialing experience required, including compliance monitoring.
• Knowledge of URAC, NCQA, or other accreditation standards is essential.

Responsibilities

• Conduct delegate credentialing audits and review policies for compliance.
• Prepare reports for credentialing committees and maintain audit tools.

Skills

Credentialing Experience

Policy Interpretation

Compliance Monitoring

Process Development

Communication Skills

Problem Solving

Education

High School Diploma or GED

Associates or Bachelor's degree in Business or Healthcare Administration

Tools

Credentialing Software

Microsoft Word

Microsoft Outlook

Job description

Credentialing Quality Coordinator (Finance)

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, Military Spouses, or Military Affiliates are encouraged to apply!

Job Summary

This position supports the Data & Credentialing Manager and is responsible for conducting delegate credentialing audits, reviewing policies and procedures, and participating in URAC, VA, or other credentialing audits. Ensures the integrity and quality of credentialing files reviewed by the Credentialing Committee. Coordinates internal reviews and audits, monitors performance standards, and recommends improvements to enhance credentialing quality. Provides oversight of credentialing/re-credentialing files, policies, and procedures for TriWest review and approval, and functions as a Subject Matter Expert on cross-functional teams regarding TriWest, VA, and accreditation standards.

Education & Experience

Required:

• High School Diploma or GED
• 2 years credentialing experience, including policy interpretation, compliance monitoring, and process development
• Healthcare background and/or Managed Care experience or experience with healthcare providers
• Knowledge of URAC, NCQA, or other accreditation standards

Preferred:

• Associates or Bachelor's degree in Business or Healthcare Administration
• VA credentialing standards experience

Key Responsibilities

• Participate in annual review of credentialing policies and procedures
• Prepare reports for credentialing committees
• Maintain audit tools and develop audit plans for delegated entities
• Conduct on-site audits and review compliance
• Develop corrective action plans
• Serve as a resource on credentialing matters
• Understand credentialing processes, systems, and data collection
• Perform other duties as assigned; regular attendance is required

Competencies

Commitment to Task: High motivation and adherence to policies

Communication / People Skills: Influence, collaboration, active listening

Computer Literacy: Proficiency in Word, Outlook, credentialing software, and report generation

Coping / Flexibility: Adaptability and problem-solving in dynamic situations

Empathy / Customer Service: Patience, respect, and customer-focused approach

Information Management: Managing complex information and drawing conclusions

High-Intensity Environment: Ability to multitask and maintain focus

Organizational Skills: Task organization, prioritization, attention to detail

Problem Solving / Analysis: Systematic process analysis and sound judgment

Technical Skills: Knowledge of credentialing processes, VA policies, and proficiency with relevant software

Working Conditions

• Availability for any shift
• Work within a standard office environment, minimal travel
• Department of Defense security clearance required

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Passionate about serving those who served? Join TriWest Healthcare Alliance! Since 1996, we've been dedicated to connecting America's heroes to healthcare in the community.

Benefits

We offer a comprehensive benefits package including:

• Medical, Dental, and Vision Coverage
• Paid Time Off
• 401(k) with matching
• Disability and Life Insurance
• Tuition Reimbursement
• Paid Volunteer Time

Salary range typically from $52,000 to $66,000 annually, depending on role and location.

Equal Employment Opportunity

TriWest is an equal opportunity employer committed to diversity and inclusion. We encourage candidates from all backgrounds to apply without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or other unlawful considerations.