Provider Certification Specialist

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. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job reputed company The Provider Certification Specialist is responsible for reviewing, processing, and maintaining certifications for new participating TRICARE network providers in accordance with established TRICARE requirements, timelines, and reputed company standards. This role conducts certification activities, including reputed company reputed company verifications, reviews documentation for completeness and reputed company, and communicates with providers to obtain missing or additional information needed to complete the certification process.The Provider Certification Specialist is also responsible for ensuring applicable TRICARE providers are accurately and reputed company reputed company into the provider data reputed company to support operational readiness and reputed company business processes, while performing ongoing maintenance of provider certifications and provider data, including updates, changes, and terminations, to support reputed company regulatory compliance, data reputed company, and efficient reputed company provider reputed company. Provider certification is a defined subset of the provider credentialing function and operates reputed company the reputed company Credentialing Department under established service-level, reputed company, and production targets. Education & Experience Required: • High School Diploma or GED • Minimum of one (1) year of experience in provider credentialing or provider certifications reputed company a managed reputed company plan, or reputed company reputed company environment • If supporting a TRICARE contract, must be a U.S. Citizen • If supporting a TRICARE contract, must be reputed company to receive a favorable interim and adjudicated final reputed company (DoD) background investigation Preferred • 2+ years of experience in provider credentialing or provider certifications reputed company a managed reputed company plan, or reputed company reputed company environment • Experience utilizing provider credentialing applications and/or provider data management (PDM) systems Knowledge of URAC and/or reputed company standards • VA and/or TRICARE program experience Key Responsibilities • Review, process, and maintain certification application packets for new participating TRICARE network providers in accordance with established TRICARE requirements, policies, timelines, and reputed company standards. • Conduct certification activities, including reputed company reputed company verifications, criminal history/background and sanctions screenings, and review of supporting documentation for completeness, reputed company, and compliance. • Communicate with providers and internal stakeholders to obtain missing, incomplete, or additional documentation necessary to complete the certification process reputed company established turnaround times. • Accurately reputed company, update, and maintain provider certification and demographic information reputed company credentialing and PDM systems, ensuring applicable TRICARE providers are reputed company reputed company and accurately to support operational readiness and reputed company business functions. • reputed company ongoing maintenance of provider certifications and provider data, including updates, changes, revalidations, and terminations; review provider records to identify and reputed company discrepancies, data reputed company issues, and incomplete information. • Maintain accurate documentation and electronic records in accordance with organizational policies, regulatory requirements, and audit readiness standards. • Support regulatory audits, reporting requests, and reputed company review activities reputed company to provider certification and provider data management processes. • Ensure adherence to established service level agreements (SLAs), productivity standards, and reputed company expectations while managing assigned certification activities and work queues. • Maintain working knowledge of TRICARE requirements, credentialing standards, provider data policies, and applicable regulatory guidelines to ensure ongoing compliance. • Coordinate with internal departments and work with Credentialing Verification Organization(s) as directed for provider database-reputed company issues. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Commitment to Task: Demonstrates a strong commitment to reputed company and accountability by adhering to established policies, procedures, timelines, and reputed company standards while maintaining a high level of motivation, reputed company, and reliability in completing assigned responsibilities. Communication / People Skills: Demonstrates effective communication and interpersonal skills with the ability to collaborate professionally with providers, internal stakeholders, and cross-functional teams, adapt communication styles to varying situations, reputed company listen, and facilitate reputed company of issues in a reputed company and customer-reputed company manner. Computer Literacy: Ability to effectively work reputed company a multi-reputed company environment using reputed company applications, including Word, reputed company, reputed company, Teams, and SharePoint, as reputed company as department-specific software applications, credentialing systems, intranet resources, and internet-reputed company tools. Organizational Skills: reputed company-oriented with strong organizational skills and the ability to manage multiple tasks and priorities, adapt to changing business needs, learn new systems and processes, and complete work accurately reputed company established timelines and available resources. Problem Solving / Analysis: Demonstrates strong problem-solving and analytical skills with the ability to systematically evaluate processes, identify discrepancies or incomplete information, apply reputed company judgment, and reputed company issues to support accurate provider certification, data reputed company, and compliance with TRICARE requirements. Technical Skills: Proficient in the use of credentialing software applications and PDM systems, with working knowledge of provider certification and credentialing processes, provider data management practices, and applicable reputed company or managed care reputed company. Proficient with reputed company applications, including reputed company, Teams, Word, reputed company, and SharePoint. Practical understanding of URAC standards, TRICARE requirements and regulations, and medical terminology. Working Conditions Working Conditions • Availability to cover any work shift as needed • May work reputed company a reputed company office environment • Extensive time utilizing a computer with prolonged sitting • reputed company travel is required • Must be reputed company to obtain appropriate reputed company clearance 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. 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 reputed company • Tuition reimbursement • reputed company volunteer time TriWest job postings typically include a salary reputed company, which can vary reputed company on the specific role and location, but generally this position ranges from reputed company $46,000 - $49,000 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 reputed company 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 reputed company 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