Team Lead, Provider Operations

TriWest Healthcare Alliance; Phoenix (AZ); Remote; USD 49,000 - 54,000; Full time

Job summary

Join a leading company as a Team Lead in Provider Operations, where you will manage critical provider data and credentialing processes. This role involves liaising with customers and ensuring compliance with healthcare standards while offering remote work opportunities across multiple states.

Benefits

Medical, dental, and vision insurance

Paid time off

401(k) plan

Disability and life insurance

Tuition reimbursement

Volunteer time

Qualifications

• 2 years of experience with healthcare/managed care programs or provider relations.
• 2 years of credentialing experience.
• If supporting TRICARE contract, must be a U.S. Citizen.

Responsibilities

• Coordinate team workload for workflows and state responsibilities.
• Provide guidance and resolve provider data, credentialing, or system issues.
• Ensure accurate and timely processing of provider data and credentialing.

Skills

Communication / People Skills

Problem Solving / Analysis

Technical Skills

Organizational Skills

Education

High School Diploma or G.E.D.

Tools

MS Word

Outlook

Excel

Teams

Job description

Join to apply for the Team Lead, Provider Operations role at TriWest Healthcare Alliance.

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

Ensures accurate, timely maintenance and synchronization of critical credentialing and provider data on all provider databases and systems, including the credentialing system. Accesses and utilizes multiple software applications. Applies business rules and knowledge of provider contract language, pricing, and reimbursement methodologies to each database/system to validate provider information. Functions as a lead liaison with customers, communicating via phone and email to address credentialing and data questions, and follow-up on issues. Meets established timelines, accuracy, and production targets. Manages large amounts of complex information, communicates clearly, and draws sound conclusions.

Education & Experience

Required:

• High School Diploma or G.E.D.
• If supporting TRICARE contract, must be a U.S. Citizen
• Favorable Department of Defense (DoD) background investigation
• 2 years of experience with healthcare/managed care programs or provider relations
• 2 years of credentialing experience

Preferred:

• 3 years of experience with healthcare/managed care programs or provider relations
• 1 year team lead experience

Key Responsibilities

• Coordinate team workload for workflows and state responsibilities.
• Provide guidance and resolve provider data, credentialing, or system issues.
• Act as liaison with network subcontractors and internal staff regarding provider data and credentialing issues.
• Ensure accurate and timely processing of provider data and credentialing.
• Analyze provider data and resolve discrepancies.
• Ensure credentialing compliance and work with Provider Services leadership.
• Generate reports and respond to credentialing inquiries.
• Draft or update department policies and procedures.
• Maintain knowledge of URAC standards and other relevant regulations.
• Work on special projects and perform other duties as assigned.

Competencies

• Commitment to Task: Conform to policies, high motivation.
• Communication / People Skills: Influence, adapt, collaborate, listen.
• Computer Literacy: Proficient in MS Word, Outlook, Excel, Teams, and departmental systems.
• Organizational Skills: Organize tasks, prioritize, detail-oriented.
• Problem Solving / Analysis: Systematic analysis, sound judgment.
• Technical Skills: Experience with provider databases, credentialing systems, and relevant regulations.

Working Conditions

• Availability for any shift.
• Standard office environment, minimal travel.
• Prolonged computer use, sitting.

Company Overview

Taking Care of Our Nation’s Heroes. It’s Who We Are. It’s What We Do.

Join TriWest Healthcare Alliance and be part of our mission to serve America’s heroes by connecting them to healthcare.

Benefits

We offer comprehensive benefits including medical, dental, vision, paid time off, 401(k), disability, life insurance, tuition reimbursement, and volunteer time. Salary range: $49,000 - $54,000 annually.

Equal Employment Opportunity

We are an inclusive employer, encouraging candidates from all backgrounds to apply, and we promote merit-based hiring without discrimination.

Additional Details

Seniority level: Mid-Senior level

Employment type: Full-time

Job function: Management and Healthcare

Industries: Hospitals and Healthcare