Triwest Remote Jobs in Arizona (NOW HIRING)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is Remote within the state of AZ only. This Remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
The Provider Relations Coordinator (PRC) is the primary BCBSAZ point of contact for contracted providers and responsible for effectively and efficiently resolving all provider issues.
REQUIRED QUALIFICATIONS
Required Work Experience

• 1 year of experience in Healthcare field (Applies to All Levels)

Required Education

• High-School Diploma or GED in field of study (Applies to All Levels)

Required Licenses

• Valid Arizona Driver License (required only for employees who reside in Arizona), with an acceptable driving record (Applies to All Levels)

Required Certifications

• N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience

• 2 years of experience in healthcare field, working with providers (Applies to All Levels)

Preferred Education

• Associate's Degree in field of study (Applies to All Levels)

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Establish and maintain positive working relationships with contracted providers, staff and internal departments
• Plans, implements and coordinates initial and ongoing provider education of professional/ancillary/hospital networks contracted for all BCBSAZ lines of business, including both the TriWest and Medicare lines of business
• Facilitates the resolution of provider inquiries and issues
• Responds timely to provider calls and emails. Works with internal departments to resolve provider issues.
• Conduct and document provider visits. Provider visits must include reconciliation of provider rosters, review of any pertinent provider reporting including scorecards, quality reporting and other reports as identified. Provider visits may also include site visits of physician offices to comply with BCBSAZ requirements in conjunction with CMS.
  • PRC provider visits must meet the following thresholds for provider visit based on type:
    • PCP no quality - at least semi-annual visits
    • PCP with quality - at least quarterly
    • Specialty no quality - at least annually
    • Specialty with quality - at least semi-annually
    • Ancillary with physical site- at least annually
    • Ancillary with no physician site (DME) - telephonic at least annually
    • Hospital system/Facility - monthly
• The position requires the PRC to attend monthly onsite staff meetings and other meetings in person, as required.

• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Provide training and on-boarding to new team members (Lead)
• Provide on-going team coach as needed (Lead)
• Work with management to identify and implement efficiency opportunities (Lead)
• Assists with oversight of assigned projects (Lead)
• Provides team support with escalated inquires (Lead)
• Maintains positive relationships with management (Lead)
• Perform all other duties or special projects as assigned

REQUIRED COMPETENCIES
Required Job Skills

• Intermediate PC proficiency (Applies to All Levels)
• Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
• Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)

Required Professional Competencies

• Ability to present and interact at a professional level (Applies to All Levels)
• Ability to problem solve (Applies to All Levels)
• Maintain confidentiality and privacy (Applies to All Levels)
• Ability to prioritize and manage work assignments and work independently (Applies to All Levels)
• Knowledge necessary to analyze reports based on available data and then make decisions based on reported data (Applies to All Levels)
• Capable of investigative and analytical research (Applies to All Levels)
• Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (Applies to All Levels)
  • Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
  • Identify root causes and initiate solutions (Applies to All Levels)
  • Ability to manage multiple large provider groups/hospitals (Applies to Levels 2 - 4)
  • Ability to train entry level staff (Applies to Levels 2 - 4)
  • Ability to communicate complex provider issues effectively (Applies to Levels 2 - 4 )
  • Demonstrates excellent relationships with providers (Applies to Levels 2 - 4)
  • Ability to manage high-level projects with minimal supervision (Applies to Level 3-4)
  • Ability to demonstrate diplomacy in all situations (Applies to Level 3-4)
  • Knowledge of claims and ability to perform claims research (Applies to Level 3-4)

Required Leadership Experience and Competencies

• Exhibit strong leadership skills (Applies to Level 3-4)
• Mentor and guide co-workers (Applies to Level 3-4)

PREFERRED COMPETENCIES
Preferred Job Skills

• Advanced skill in word processing, spreadsheet and database software (Applies to All Levels)

Preferred Professional Competencies

• Knowledge of provider reimbursement methodologies contracts and networks (Applies to All Levels )
• Knowledge of claims payment systems and ability to perform preliminary claims research (Applies to All Levels)

Preferred Leadership Experience and Competencies

• Ability to positively influence others (Applies to Level 3-4)
• Considered role model for co-workers (Applies to Level 3-4)

Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.