Reporting to the Provider Services Systems & QA Manager, this position is responsible for oversight of the data management, credentialing, customer relationship management (CRM), quality, training and documentation processes that support the operations of the Provider Services department. This position has oversight of the following core operations systems - Provider data management, Credentialing and customer relationship management.
The supervisor provides subject matter expertise for data integration between Provider Services systems and other internal departmental operational systems such as referral management, claims, provider directory and data warehouse.
The supervisor ensures data accuracy within provider databases and the Provider Services call center. The supervisor assists in projects from start to finish; coordinates the integration of office operations and on-line systems.
• Oversees the Emptoris contract management system; approval process, contract template changes, version control, and overall administration of system security within Provider Services.
• Initiates and assists in the managing of the change order process for Provide Services and coordinates with network subcontractors ensuring adherence to implementation schedules
• Ensures compliance with contract requirements for NCDR, STS.
• Compliance reporting which includes URAC reporting for the department.
• Reports on service levels within Provider Services through the creation of performance dashboards that illustrate performance to plan using established department service metrics.
• Creates and supervises quality assurance and training programs to improve operational performance.
• Assists in developing ongoing metrics and monitoring processes to assess effectiveness and efficiency for continuous improvement. Identifies staff development needs and recommends training plans.
• Assists in plans and designs performance systems supported by benchmarking, cost analysis, business cases, and other criteria. Participates in the implementation of systems designed to measure process and performance. Contributes to program governance, project reviews, cross-functional communications and training. Contributes to quality projects. Assists in evaluating case reviews to identify and address quality and service improvement opportunities.
• Partners cross-functionally to promote high-quality service levels throughout TriWest.
• Develops and supervises effective training to drive continual quality improvement to cultivate a high performance workforce.
• Supervises daily operational resources, tracking results against requirements.
• Supervises department staff, assigning and monitoring workflow, manages performance and provides guidance.
• Delivers on-the job training and coaching.
• Participates in special projects and meetings.
• Performs other duties as assigned.
• Attends meetings or functions outside of normal business hours.
• Regular and reliable attendance is required.
Education & Experience
• Bachelor's degree with 2 years of provider operations experience or equivalent work experience
• Supervisory or leadership experience
• Provider database management experience
• Training and process improvement experience
• Excellent written and verbal communications skills
• Knowledge of government programs administered by TriWest
• Experience with Emptoris contract management system
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