Dir, Provider Sys & Quality (Finance)

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 Director is responsible for leading the Provider Services Systems and Quality department, ensuring the efficient management and integrity of provider data across contracting, credentialing, external interfaces, and quality functions. This role provides strategic leadership, overseeing data governance, system enhancements, audits, and compliance to support healthcare operations. The Director defines user requirements, establishes data standards, and implements performance metrics to maintain excellence in provider data management. Additionally, this position drives continuous process improvement and ensures alignment with regulatory and industry standards to enhance TriWest's provider network.

Education & Experience

Required:

• Bachelor's degree in Business Administration, Healthcare Management, or a related field, or equivalent experience
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 5+ years of progressively responsible management experience in a Managed Care environment, overseeing provider network operations
• 3+ years of experience in provider data management, including oversight of contract terms, credentialing status, claims data, and quality data integrity
• 3+ years of experience successfully managing large teams and other leaders in a high-volume production environment
• Demonstrable skills and experience in strategic planning, program management, staff development, and the creation and presentation of performance reports

Preferred:

• Bachelor's or master's degree in business analytics or data science
• Experience with government healthcare programs (e.g., Veterans Affairs, TRICARE, Medicare)
• Knowledge of Lean Six Sigma or other process improvement methodologies
• Familiarity with cloud-based healthcare data platforms and automation technologies
• Experience with maintaining provider directory accuracy and related audits

Key Responsibilities

Leadership & Team Development:
• Lead the Provider Services Systems and Quality department, ensuring alignment with organizational goals and performance metrics.
• Provide strategic direction, mentorship, and coaching to optimize individual and team performance.
• Foster a collaborative and high-performance culture, driving continuous improvement in provider data management. Provider Data Governance & Accuracy:
• Oversee the quality, accuracy, and integrity of the provider master database, ensuring compliance with industry standards.
• Manage provider data lifecycle, from contracting and credentialing to data interfaces and external integrations.
• Ensure data validation, source verification, and entry processes meet regulatory and operational requirements. System Enhancements & IT Collaboration:
• Serve as the business owner for provider data systems, identifying and implementing enhancements to improve efficiency.
• Lead database optimization initiatives, working closely with IT to resolve system issues and maintain data integrity.
• Ensure seamless integration of provider data with external partners, including claims payors, provider directories, and medical management systems.

Operational Excellence & Compliance:
• Develop and maintain performance dashboards and reports, providing insights to senior leadership and key stakeholders.
• Ensure network provider data accuracy exceeds industry standards, supporting claims processing, authorization, and referral management.
• Oversee audit and compliance efforts, ensuring provider data aligns with regulatory requirements and best practices. Resource & Budget Management:
• Define staffing needs, allocate resources, and oversee recruitment, training, and professional development.
• Develop and manage budgetary requirements, recommend system enhancements and forecast resource needs.
• Collaborate with external entities to drive continuous quality improvement in provider data management. Stakeholder Engagement & Strategic Initiatives:
• Represent the organization in provider data-related discussions, ensuring alignment with business users and external partners.
• Drive innovation and process improvements, leveraging technology and data analytics to enhance provider network operations.
• Maintain regular and reliable attendance, ensuring leadership presence and operational continuity.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

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.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

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.

Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.

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.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Knowledge of provider systems; knowledge of credentialing principles, practices, and standards; strong leadership skills to lead major systems change processes; technical systems knowledge to manage IT interface on systems issues; knowledge of health care systems organization, administration, and service delivery; collaboration skills, with ability to build external relationships to achieve positive outcomes; knowledge of state and federal regulations governing health care systems and practices; knowledge of cost control methods for operational systems; program development experience; knowledge of professional practice standards, quality improvement, and research activities for large health care systems; group presentation skills; training and development skills for mentoring technical skills of staff.

Working Conditions

Working Conditions:

• Availability to work non-regular hours as necessary
• Works within a hybrid environment
• Limited travel
• 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
• Generous 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 $156,000 to $174,000 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.