Provider Relations Rep

Job Summary

This position supports the department leadership in the overall management of the TriWest provider networks. Ensures high level of customer satisfaction by serving as the consulting resource for the Provider Services Department and TriWest. Serves as the subject matter expert by educating providers on TriWest provider agreements, reimbursement methodologies, provider education content, contract requirements, and new programs. Facilitates research, resolution, and tracking of escalated provider issues. This position must keep current and follow VA, TRICARE, 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 :

• Bachelor's (BA / BS) Degree in health care or related field or equivalent experience
• If supporting TRICARE contract, U. S. Citizenship
• If supporting TRICARE contract, must be able to receive a favorable interim and adjudicated final Department of Defense (DoD) background investigation
• 3 years managed health care experience (provider relations and / or provider education) or experience working for a health care provider, with increasing responsibility
• Provider contracting experience
• Ability to work in a highly matrixed environment
• Ability to work in a fast-paced environment and triage constantly changing priorities

Preferred :

Key Responsibilities

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.

Working Conditions