Provider Credentialing Specialist

Profile

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

The Provider Credentialing Specialist supports the Credentialing Department by managing and maintaining accurate, up-to-date provider data to include updates, changes, additions and terminations in the credentialing, while working under timeline, accuracy and production targets. Performs credentialing activities including primary source verifications, communicating with Providers to request missing information supporting the integrity of Provider data in all downstream systems, and key-entering initial data of potential network Providers into the credentialing system.

Education & Experience

Required:

• High School Diploma or GED
• 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
• 6 months or more of provider credentialing experience
  
  

Preferred

• 1 years of credentialing experience
• Experience using provider credentialing software systems or Provider Data Management Systems
• Knowledge of URAC or NCQA standards
  
  

Key Responsibilities

• Process Provider credentialing inventory within expected timeline, accuracy and production targets.
• Update outdated provider credentialing and demographic information.
• Reviews Provider applications and verifies that each meets all credentialing criteria.
• Reviews Provider applications for accuracy and completeness and follows-up to obtain missing information materials in a timely manner and in accordance with department standards.
• Queries primary sources, as applicable, to verify Provider credentials and qualifications.
• Prepares files for review by the Credentialing Committee.
• Maintains current credentialing, directory status information in a Provider credentialing system (Provider database).
• Represents the Credentialing Unit at Credentialing Committee meetings as needed.
• Achieves and maintains required department credentialing timeframe standards.
• Communicates, though both written and verbal communication, in a professional and concise manner and is able to share information and/or instructions for updating and correcting Provider credentialing databases.
• Coordinate with internal departments for Provider database related issues.
• Works with Credentialing Verification Organization(s) as directed.
• 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 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: Detail-oriented with the ability to organize people or tasks, adjust priorities, learn systems, within time constraints and with available resources.

Problem Solving / Analysis: Able 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 credentialing software systems, Provider Data Management Systems, and Provider Information Management Systems; working knowledge of Provider credentialing policies and procedures, healthcare or managed care experience

Working Conditions

• Availability to cover any work shift
• Works within a standard office environment, with minimal travel
• Extensive computer work with prolonged periods of sitting
  
  

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
• 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 $44,000 to $56,000 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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.