Supervisor, Provider Operations

TriWest Healthcare Alliance; Phoenix (AZ); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a Supervisor for Provider Operations to oversee provider data management and credentialing teams. The role involves ensuring compliance with regulatory guidelines, managing workflows, and providing staff training. Candidates should have a Bachelor's degree and supervisory experience, with a focus on communication and problem-solving skills. Remote work opportunities are available for eligible states.

Qualifications

• 2 years supervisory experience or leadership skills.
• Working knowledge of the credentialing process and regulatory compliance.

Responsibilities

• Supervises provider data management and credentialing teams.
• Coordinates provider data correction requests and manages department workflow.
• Ensures compliance with established policies and procedures.

Skills

Communication

Leadership

Problem Solving

Customer Service

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Outlook

Visual Cactus

Job description

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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
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
- 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

Preferred
- VA Program 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 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 regulations.
• Continuously examines 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 staff is fully-informed through regular meetings; establishing and maintaining performance standards; addressing staffing and performance issues; performing monthly one-on-ones; providing performance feedback; and conducting 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; adapt to different styles; listen critically; collaborate.
• Computer Literacy: Proficiency in Microsoft Word, Outlook, TriWest Intranet, Internet, and department software applications.
• Coping / Flexibility: Resiliency in adapting to various situations and individuals while maintaining purpose and problem-solving approach.
• Empathy / Customer Service: Customer-focused behavior; listening skills, patience, respect, and empathy.
• Independent Thinking / Self-Initiative: Critical thinking; focus on outcomes; proactive resourcefulness.
• Information Management: Ability to handle complex information, communicate clearly, and draw conclusions.
• Leadership: Manage different employee styles; provide clear direction and coaching.
• Problem Solving / Analysis: Solve problems systematically; sound judgment.
• Technical Skills: Knowledge of credentialing process; proficient with Word, Excel, Visual Cactus, credentialing software; familiar with VA policies and DoD regulations.