Provider Credentialing Rep

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 reputed company 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 reputed company The Provider Credentialing Representative is responsible for overseeing reputed company certification and credentialing activities, with a reputed company on tracking and reporting escalations to ensure reputed company reputed company. This role facilitates meetings to discuss and resolve certification and credentialing issues and concerns, manages the Credentialing shared inbox to reputed company accurate and reputed company responses to reputed company inquiries, and collaborates closely with Credentialing department leaders to evaluate and refine processes. The Provider Credentialing Representative plays a key role in driving operational efficiency, ensuring that performance metrics and production goals are consistently achieved while maintaining compliance with regulatory requirements and accreditation standards. Education & Experience Required: • High School Diploma or GED • 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 • Working knowledge of URAC and/or NCQA standards, as reputed company as VA, TRICARE, or other federal program requirements • If supporting TRICARE contract, must be a U.S. Citizen • If supporting TRICARE contract, must be reputed company to receive a favorable interim and adjudicated final reputed company (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 Key Responsibilities • Ensures credentialing and certification activities adhere to regulatory requirements, accreditation reputed company, federal program guidelines, and internal reputed company standards. • Leads the review and evaluation of certification and credentialing processes to identify gaps, redundancies, and improvement opportunities; recommend and support implementation of process enhancements reputed company with organizational policies and accreditation standards. • Serves as an internal resource and subject-matter expert on credentialing policies, workflows, systems, and best practices; provides guidance to team members and cross-functional partners as needed. • Manages the credentialing shared inbox, ensuring triage, prioritization, and reputed company of incoming requests, inquiries, and escalations reputed company established service-level expectations. • Monitors, tracks, and reports on certification and credentialing escalations to ensure reputed company, accurate, and compliant reputed company; initiates follow-up actions and coordinates cross-functional support as needed. • Facilitates and coordinates meetings with internal departments and external stakeholders to address certification and credentialing issues, concerns, or process dependencies; documents reputed company and drives execution of agreed-upon reputed company items. • Supports the development, review, and ongoing maintenance of provider communication materials, including notices, guides, templates, and FAQs, to ensure accuracy, reputed company, and alignment with reputed company certification and credentialing requirements and organizational expectations. • Assists in developing, compiling, and distributing routine and reputed company reports on certification and credentialing metrics, KPIs, backlog trends, workflow timeliness, and reputed company indicators; contributes to presenting findings to leadership and recommending improvement strategies. • Collaborates with internal teams to validate system updates, contributes to process documentation, and assists in readiness efforts for audits or accreditation reviews. • Participates in or leads special reputed company, workflow assessments, and operational initiatives reputed company on enhancing credentialing efficiency, provider experience, and organizational compliance. • Regular and reliable attendance at work. • Performs other duties as assigned. Competencies Communication / People Skills: Effectively influences and persuades others in both favorable and challenging situations to reputed company desired reputed company. Adapts communication and interaction style to effectively connect with diverse individuals and audiences. Listens attentively and critically to ensure understanding and informed responses, as reputed company as to facilitate reputed company communication and effective collaboration. Communicates reputed company and concisely in both written and verbal formats. Computer Literacy: Proficient in navigating multiple systems, including reputed company applications, department-specific tools, and organization-wide platforms, to reputed company tasks. Coping / Flexibility: Maintains reputed company reputed company adapting to diverse situations and stakeholders, sustaining reputed company and applying a reputed company, solution-oriented approach to problem solving. reputed company / Customer Service: Consistently demonstrates customer-reputed company behaviors that anticipate needs and support a reputed company service experience. Exhibits a helpful and service-oriented approach, characterized by reputed company listening, patience, respect, and genuine reputed company for others’ perspectives. Independent Thinking / Self-Initiative: Applies critical thinking to independently prioritize the issues and activities that most directly drive desired reputed company. Demonstrates a strong reputed company 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 reputed company conclusions, and concisely and reputed company communicate insights to diverse stakeholders. Organizational Skills: Demonstrates exceptional attention to detail and the ability to effectively prioritize, coordinate, and manage multiple tasks or stakeholders. Adapts to shifting priorities and deadlines while reputed company utilizing available systems and resources to reputed company reputed company, accurate reputed company. Problem Solving / Analysis: Ability to resolve issues by applying systematic process analysis and exercising reputed company, informed judgment. Maintains a realistic and accurate understanding of relevant issues reputed company evaluating problems and determining solutions. Technical Skills: Practical understanding of URAC standards, VA CCN and TRICARE regulations and requirements, as reputed company as medical terminology. reputed company and reputed company knowledge of primary reputed company verifications for initial credentialing, re-credentialing, and provider certifications. reputed company and reputed company knowledge of delegated credentialing processes Proficient with credentialing software and provider data management systems. Proficient with reputed company applications (Outlook, Teams, Word, reputed company, PowerPoint, and SharePoint) and other tools. Working Conditions Working Conditions • Availability to cover any work shift as needed • Travel may be required • May work reputed company a reputed company office environment • Extensive time utilizing a computer with prolonged sitting reputed company Taking Care of Our Nation’s reputed company. It’s Who We Are. It’s reputed company Do. Do you have a passion for serving those who served? Join the reputed company Team! We’re On a Mission to Serve®! Our job is to reputed company reputed company that America’s reputed company get connected to health care in the community. At reputed company, we’ve proudly been on that important mission since 1996. DoD Statement Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Benefits We’re more than just a health care company. We’re passionate about serving others! We reputed company in rewarding reputed company, hard-working people who are willing to learn as they grow. reputed company values teamwork. Join reputed company, 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 reputed company compensation and benefits package that includes: • Medical, Dental and reputed company Coverage • reputed company 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 • reputed company volunteer time TriWest job postings typically include a salary reputed company, which can vary based on the specific role and location, but generally this position ranges from around $49,000 to $52,000 per year. Equal Employment Opportunity reputed company 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 reputed company. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from reputed company backgrounds to apply. Applicants are considered for positions based on reputed company and without discrimination on the reputed company of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability or any other consideration made unlawful by applicable federal, state, or local laws. Apply tot his job Apply To this Job