We offer remote work opportunities (AK, AZ, HI, ID, NV, NM, OR, TX, UT, VA, WA and WY only)

This position supports the department leadership in the overall management of provider education as it relates to TriWest provider networks. Ensures high level of customer satisfaction by serving as the consulting resource for the Provider Services Department and TriWest network subcontractors. Serves as the subject matter expert by educating providers on TriWest reimbursement methodologies, provider education content, contract requirements, and new programs. Provides suggestions to update provider education materials based on trends and operates as intermediary between network subcontractors and TriWest staff on provider education needs. Facilitates resolution of escalated provider issues and communicates outcomes. Ensures compliance with network subcontractor statement of work requirements and overall account management for assigned states. This position must keep current and follow VA, TriWest, and departmental policies and procedures and submit reports in a timely manner. Assigned territory may cover four to nine states in the designated VA Region.

Education & Experience

Required:
o Bachelor's (BA/BS) Degree in health care or related field or equivalent experience.

o 3 years managed health care experience (provider relations and/or provider education) or experience working for a health care provider, with increasing responsibility.

o Provider contracting experience.

o Ability to work in a highly matrixed environment.

o Ability to work in a fast-paced environment and triage constantly changing priorities.

Preferred:
o Experience processing referrals/authorizations or claims or handling escalated provider issues to resolution.

o Experience with healthcare-related electronic transactions and reimbursement methodologies.

o Experience in leading and facilitating meetings.

Key Responsibilities

o Monitor assigned area against established network adequacy and access standards. This includes coordination with network subcontractors to provide written narratives on contracting efforts. o Document and follow-up on access to care issues. Monitor the network to ensure appropriate network subcontractor action to eliminate network shortfalls.

o Serves as the primary contact and resource for assigned network subcontractor(s) in order to provide assistance and advice for delegated activities.

o Establish and maintain positive working relationships with both internal and external customers. Responding to emails, phone calls, customer service inquires by fully researching inquiry and responding timely.

o Subject matter expert of VA payment methodologies and TriWest policies and procedures for the administration of the VA Program.

o Ensure network subcontractors comply with Statement of Work, by overseeing and ensuring requirements are met. o Coordinate and ensure timely provider contracting and re-contracting projects. o Issue management and resolution of escalated issues; resolving provider issues in collaboration with Claims and Operations departments and reporting updates to the VA.

o Maintains professional working relationship with other TriWest departments, network subcontractors, and to stay abreast of provider educational needs.

o Remains current on all VA, TriWest and departmental policies and procedures by taking all available training and reviewing e-mail, TriNet, and www.triwest.com communications.

o Recommends future provider educational needs based on observations of and discussions with providers and provider questions during live and web-based training. o Provides feedback to management of any claims processing, referral/authorization, or other unfavorable trends from provider interactions.

o Actively promotes electronic claims submission & secure website functionality in all provider interactions. o Maintains accurate provider contact records in the contact management system.

o Reviews and submits feedback timely on draft provider educational materials.

o Assists/participates in projects as assigned by Manager.

o Performs other duties as assigned.

o Regular and reliable attendance is required.

Competencies

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.

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

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

Technical Skills: The ability to solve problems independently while working in a fast paced, energetic environment; strong communication skills, (oral and writing skills); a proven ability as a facilitator/instructor; self motivated, able to work in a team and independently.

Company Overview

Taking Care of Our Nation’s Veterans.

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.

For more information about TriWest, please explore our website at www.triwest.com.

Benefits

More About Working at TriWest Healthcare Alliance

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

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. All qualified applicants are considered for employment, without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic made unlawful by applicable federal, state, or local laws.

Are you ready to make a difference in the lives of our nation’s heroes?

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