Description

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.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

The Supervisor, Provider Certification & Credentialing oversees the daily operations of the department to ensure all healthcare providers are properly certified and credentialed in compliance with regulatory, contractual, and accreditation standards, including URAC, VA, and TRICARE requirements. This role ensures the timely and accurate processing of provider certifications, initial credentialing, re-credentialing, and delegated credentialing activities, while maintaining provider data integrity in the credentialing system.

Education & Experience

Required:

• Bachelor's degree in healthcare administration, business administration, or related field; or equivalent work experience
• 2+ years of supervisory experience or similar leadership role
• 2+ years of provider credentialing experience
• 2+ years of experience working with credentialing applications and provider data management systems to support end-to-end credentialing and data workflows
• Solid understanding of provider credentialing processes (initial, re-credentialing, delegated), provider certification processes, provider data management processes, accreditation standards for URAC and/or NCQA, and regulatory requirements for VA and/or TRICARE
• 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

Preferred:

• 3+ years of provider credentialing experience
• 3+ years of experience working with credentialing applications and provider data management systems to support end-to-end credentialing and data workflows
• VA and/or TRICARE program experience
• Strong written and verbal communication skills
• Ability to work under minimal supervision and make independent decisions within established guidelines

Key Responsibilities

• Manages team workload and workflow, ensuring timely tracking and reporting of established performance goals and production metrics. Addresses performance issues promptly and implements performance improvement plans when necessary.
• Coaches and mentors direct reports to foster accountability, strengthen skills, and support ongoing professional development.
• Collaborates with internal departments and CVOs to resolve credentialing and data-related issues, ensuring regulatory compliance and exceptional customer service.
• Conducts annual performance reviews for direct reports in alignment with TriWest guidelines, providing clear feedback, development planning, and performance documentation.
• Ensures staff remain well-informed through regular team meetings and addresses individual concerns and issues through consistent one-on-one meetings.
• Develops and delivers training to team members, ensuring timely communication of new or updated processes, regulations, and standards.
• Supervises daily operations for initial credentialing, re-credentialing, delegated credentialing, provider certifications, and the loading and maintenance of provider data (adds, changes, terminations) for direct and corporate-contracted providers.
• Ensures accurate and timely entry of provider data into the credentialing/provider data management system in accordance with established guidelines and procedures.
• Coordinates and drives the timely completion of credentialing projects and escalated requests.
• Participates in regular evaluations of departmental procedures and workflows to identify enhancement opportunities, leveraging existing or emerging technologies, tools, and resources to optimize efficiency and performance.
• Leads and executes internal audits of credentialing files to identify potential compliance risks, implement corrective actions, and ensure adherence to regulatory requirements and accreditation standards.
• Assists in the development and administration of the annual audit plan for all delegated entities, including network subcontractors, direct-contracted providers, and corporate-contracted providers.
• Supports the preparation of accurate, timely responses for credentialing-related audits, encompassing internal audits, monthly and annual regulatory reviews, and accreditation audits.
• Serves as the primary credentialing point of contact for internal teams and stakeholders, ensuring timely communication, coordination, and issue resolution.

.:

• Ensures team compliance with organizational policies, regulatory requirements, and accreditation standards.
• Attends meetings outside of normal business hours as required.
• Regular and reliable attendance at work.
• Performs other duties as assigned.

Competencies

Coaching / Training / Mentoring: Drives desired business outcomes by providing consistent, constructive feedback and guidance. Designs and delivers impactful team training on processes, regulatory requirements, accreditation standards, and system applications. Guides staff in creating and implementing individualized professional development plans.

Communication / People Skills: Effectively influences and persuades others in both favorable and challenging situations to achieve desired outcomes. Adapts communication and interaction style to effectively connect with diverse individuals and audiences. Listens attentively and critically to ensure understanding and informed responses, as well as to facilitate clear communication and effective collaboration. Communicates clearly and concisely in both written and verbal formats.

Computer Literacy: Proficient in navigating multiple systems, including Microsoft applications, department-specific tools, and organization-wide platforms, to perform tasks.

Coping / Flexibility: Maintains resilience when adapting to diverse situations and stakeholders, sustaining focus and applying a professional, solution-oriented approach to problem solving.

Empathy / Customer Service: Consistently demonstrates customer-focused behaviors that anticipate needs and support a positive service experience. Exhibits a helpful and service-oriented approach, characterized by active listening, patience, respect, and genuine empathy for others' perspectives.

Independent Thinking / Self-Initiative: Applies critical thinking to independently prioritize the issues and activities that most directly drive desired outcomes. Demonstrates a strong sense of ownership by advancing work independently, securing required resources, and driving tasks to completion without the need for direction.

Information Management: Ability to analyze large volumes of data, derive sound conclusions, and concisely and clearly communicate insights to diverse stakeholders.

Leadership: Leads and develops employees with diverse backgrounds and work styles, adapting approaches to optimize performance and collaboration. Delivers clear direction and provides effective coaching to drive team alignment and performance.

Problem Solving / Analysis: Ability to resolve issues by applying systematic process analysis and exercising sound, inf ormed judgment. Maintains a realistic and accurate understanding of relevant issues when evaluating problems and determining solutions.

Technical Skills: Practical understanding of URAC standards, VA CCN and TRICARE regulations and requirements, as well as medical terminology. Current and advanced knowledge of primary source verifications for initial credentialing, re-credentialing, and provider certifications. Current and advanced knowledge of delegated credentialing processes. Proficient with credentialing software and provider data management systems. Proficient with Microsoft applications (Outlook, Teams, Word, Excel, PowerPoint, and SharePoint) and other tools.

Working Conditions

Working Conditions:

• Availability to cover any work shift as needed
• Travel may be required
• May work within a standard office environment
• Extensive time utilizing a computer with prolonged sitting
• Must be able to obtain appropriate security clearance

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 $72,000 - $80,000 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.