Job Summary We offer remote work opportunities (AK, AZ, HI, ID, NV, NM, OR, TX, UT, VA, WA and WY only) 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. Are you our next Provider Relations Rep? 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. 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. Are you qualified? · Are you a Veteran, family member of a Veteran, a friend of a Veteran, or passionate about helping Veterans? · Do you have your Bachelor's (BA/BS) Degree in health care or related field or equivalent experience? · Do you have 3 years managed health care experience (provider relations and/or provider education) or experience working for a health care provider, with increasing responsibility? · Do you have Provider contracting experience? · Do you have the ability to work in a highly matrixed environment? · Do you have the ability to work in a fast-paced environment and triage constantly changing priorities? Preferred o Do you have experience processing referrals/authorizations or claims or handling escalated provider issues to resolution? o Do you have experience with healthcare-related electronic transactions and reimbursement methodologies? o Do you have Experience in leading and facilitating meetings. 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 respon
Taking Care of Our Nation’s Veterans. \r\nIt’s Who We Are. It’s What We Do.\r\nDo you have a passion for serving those who served? \r\n \r\nJoin the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!\r\n \r\nOur job is to make sure that America’s heroes get connected to health care in the community. \r\n \r\nAt TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.