Job Summary

Ensures accurate, timely maintenance and synchronization of critical provider data across all provider databases and systems. 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 across systems. Communicates with internal and external clients by phone and email to clarify data and follow-up on issues, while working under timeline, accuracy, and production targets. Requires the ability to manage a large amount of complex information and must be able to communicate clearly and draw sound conclusions. Supports the maintenance of accurate, up-to-date provider data to include updates, changes, additions and terminations for assigned files.

Education & Experience

Key Responsibilities

• Process provider data inventory within expected timeline while meeting accuracy and production targets.
• Identify, research, and analyze issues received to determine appropriate handling. Resolve provider data correction requests in a specified time frame. Manage daily follow up of Provider data correction requests and resolve all issues to ensure databases are current and accurate.
• Maintain and process reimbursement terms to ensure correct claims payment and downstream processing.
• Review Provider contract language and identify when the contract is out of compliance. Process Provider contracts, run reports and respond to inquiries regarding contract compliance issues; image and index contracts and return images to network subcontractors. Conduct quality assurance activities to ensure image quality and completion of image activities.
• Support requests for assistance and research issues using various resources including online searches and phone calls.
• Communicate clearly through both written and verbal forms of communication and follow up with various parties to ensure tasks are completed within the allotted timeline or issues are escalated appropriately.
• Coordinate with internal departments for provider database related issues.

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 unique styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Excel, Outlook, TriWest Intranet, the Internet, and department software applications.

Organizational Skills: Ability to multi-task, adjust to priorities and learn new systems, within the time constraints and with available resources; must be 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: Proficient with key databases, including FoxPro, Claims Systems, Medical Management Systems, and Provider Data Management Systems; working knowledge of VA policies and procedures, current knowledge of claims, reimbursement methodology; healthcare or managed care experience.

Working Conditions

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.

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

In order to apply, you must submit your current resume through PeopleSoft in an electronic format, and submit a completed Internal Interview Request form to Human Capital. The form can be found on TriNet under Forms Repository/Human Capital.

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 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.