Provider Relations Executive - TriWest Programs

Overview

Provider Relations Executive - Tri West Programs

Hybrid opportunities in Portland, OR;
Medford, OR;
Vancouver, WA;
Burlington, WA;
Renton, WA;
Spokane, WA;
Salt Lake City, UT;
Lewiston, ;
Boise,

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Every day, Cambia’s dedicated team of Provider Relations Executives are living our mission to make health care easier and lives better. As a member of the Tri West Provider Relations and Contracting team, our Tri West Provider Relations Executives oversee TRICARE and VA CCN contract management, facilitating coordination between Cambia departments, Tri West, network leadership, and providers to ensure seamless provider experiences, resolve issues, and build strong relationships – all in service of making our members’ health journeys easier.

• Qualifications: Provider Relations Executive would have a Bachelor’s degree in Healthcare Administration or related field and a minimum of 5 years of experience in the healthcare industry with specific focus in provider relations, provider contracting, customer service, financial analysis: provider/payer strategy development or implementation; provider/payer contracting and reimbursement, preferably managed care; delivery system administration, or equivalent combination of education and experience.
  
  Valid driver’s license is required.

• Skills and Attributes: Strong communication and facilitation skills to deliver challenging messages with diplomacy while maintaining strong relationships with provider partners.
• Self-directed with creative problem-solving skills to identify problems, develop solutions, and implement a chosen course of action to resolve issues and build consensus among diverse stakeholders.
• Professional presence, leadership, and knowledge of helping complex organizations affect change to improve their operations.
• Strong critical thinking, consulting, and influencing skills to present complex information simply and succinctly at all levels of the organization.
• Ability to effectively manage a variety of formal presentation settings, prioritize work, and meet timelines.
• Knowledge of healthcare systems, including provider coding, reimbursement, contract methodologies, products, and networks, as well as the inputs to the total cost of care for a population.
• Proficiency in using Microsoft Office tools, with the ability to travel extensively within the state and work in a high-pressure environment while managing conflict and ambiguity.

• Act as the liaison between providers and Tri West for the purpose of building and maintaining Tri West’s provider networks.
• Develops and fosters collaborative partnerships with key providers and internal stakeholders, establishing credibility as a trusted advisor and resource to influence positive change.
• Documents provider information, tracks and reports performance metrics, and ensures providers have access to reports and tools to drive performance.
• Maintains knowledge of contract terms and performance targets, educates providers and internal stakeholders, and facilitates executive-level Joint Operating Committees to discuss performance and collaboration opportunities.
• Facilitates internal and external work groups to review performance reports, identify opportunities, and drive action plans to improve clinical quality, cost containment, member experience, and provider experience.
• Coaches providers to improve member health outcomes through engagement and enablement, monitors progress and communicates performance expectations to drive change.
• Identifies and leads new initiatives to assist providers in transitioning to innovative payment models and manages the implementation of cross-functional organizational strategies to improve provider and member experience.
• Serves as a subject matter expert on competitive intelligence, supports development of innovative programs, and represents the health plan's position on local and national provider programs.

The expected hiring range for a Provider Relations Executive is $84,200 - $113,900 depending on…