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.

Veteran, Military Spouse or Military Affiliated are encouraged to apply!

Job Summary

This position supports the Data & Credentialing Manager and is responsible for conducting Delegate new and annual Credentialing Audits, review of P&P's yearly and participates with any URAC, VA or any credentialing audits. Ensures the integrity and quality of the credentialing files under review by the Credentialing Committee. Coordinates the internal review and audit process including monitoring production and quality goals and standards for performance. Makes recommendations for improvements to enhance credentialing program quality standards. Provides quality oversight of credentialing/re-credentialing files, plans, policy and procedures for TriWest review and approval and the Direct Credentials Committee. Functions as Subject Matter Expert on cross-functional teams regarding TriWest requirements, VA contract requirements and URAC standards or other Accreditations.

Education & Experience

Required:
High School Diploma or GED
• 2 years credentialing experience o Experience in interpreting policies, monitoring compliance, and developing processes o Healthcare background and/or Managed Care experience or experience working for a health care provider with increasing responsibilities
• Working knowledge of URAC or NCQA credentialing standards or other Accreditation Program experience

Preferred:

• Associates or Bachelor's degree in Business, Health Care Administration
• VA credentialing standards

Key Responsibilities

Participates in the annual review of the Direct Credentialing Unit's plan, policies, and procedures including those relating to oversight of delegated entities. o Reviews and prepares reports to the Direct Credentialing Committee of network delegated entities for higher-level review and approval. o Maintains all audit tools for internal and external audits. o Develops and maintains a credentialing audit plan for delegated entities including on-site audits, review of policies and procedures, and compliance review with TriWest requirements, VA contract and URAC or other Accreditation programs regulations. o Schedules and conducts annual credentialing audits at delegated entities. o Develops and monitors corrective action plans for delegated entities. o Functions as a resource on credentialing matters. o Must possess an understanding of the credentialing processes, system and data collection. Performs other duties as assigned. Regular and reliable attendance is required.

Competencies

Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.

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.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.

Technical Skills: Thorough knowledge and complete understanding of the credentialing process and requirements; Proficient with Word, Excel, Visual Cactus, credentialing software, and the ability to produce reports through querying; Working knowledge of the VA policies and procedures outlined in the VA Operations manual, VA Policy Manual, DoD Regulations

Working Conditions

o Availability to work any shift

o Works within a standard office environment, with minimal travel

o 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.

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.

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
• Generous 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 $52,000 to $66,000 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 cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions 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.