Provider Relations Account Manager II - BH

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Under the direction of the Manager, Provider Account Management (PAM), the PAM 2 will play a critical role in developing and maintaining key provider constituent relationships while serving as the primary point of contact for resolving escalated provider operational issues that may impact contract and/or overall Point32Health business strategy. The individual will act as a senior liaison promoting mutually positive relationships through coordination and collaboration with leveraged and critical providers, hospital associations, medical societies and professional trade associations, and vended partners across the multi-state delivery and enterprise systems. This role serves as a Provider Account Manager coordinating monthly and quarterly Business Operations and Steering Committees.
Role responsibilities include the coordination of Point32Health’s critical provider related constituent relationships, escalated issue management and dispute resolution activities. He/she collaborates with external and internal cross-functional resources to ensure the needs of the provider network are met, including timely resolution of high impact claim or operational issues. This individual may interact directly with providers and office staff at various levels as needed and will serve as a subject matter expert providing consultative services internally with other key stakeholders such as claims, contracting, call center, plan specific and or policy teams.

Job Description

• Acts as the primary point of contact for complex operational issues and is responsible for identifying and documenting issues including but not limited to developing action plans, testing feasible solutions, guiding resolution and communicating to the appropriate personnel within Point32Health and the provider site.
• Leads and facilitates regular internal and external meetings at the Provider sites (defines and develops agendas, keeps meetings on track, documents and distributes meeting minutes and manages all follow-up tasks.)
• Continuously enforces/ maintains the servicing model and makes recommendations for improvements as needed.
• Conducts operational trendspotting and makes recommendations for process development, enhancement and resolution.
• Participates in various departmental initiatives, projects or committee meetings as assigned by management.
• Other duties as assigned by management.

• B.A. or B.S. or commensurate experience required.
• Master's degree in health care or business preferred.
• 4-5 years’ work experience in health care, claims operations or billing/ revenue cycle required.
• Computer skill required: Excel (advanced), Word, Power Point and Visio.
• Strong presentation skills required
• Strong project management skills required
• Candidates must have strong and effective communication skills and experience – both verbal and in writing
• Requires a high level of initiative, sound judgment, organization and the ability to work independently under pressure in a constantly changing environment.
• Must be able to balance and appropriately prioritize multiple tasks.
• Requires the ability to analyze and resolve complex operational concerns and to appropriately escalate issues. Excellent problem solving, team participation, and relationship building skills are essential – including the identification of root cause and recommended solutions
• Requires comprehensive knowledge of managed care concepts and Point32Health financial risk arrangements to identify problems and facilitate timely resolutions that will positively affect the health plan and the provider unit.
• Requires sound knowledge of all Point32Health products and their respective policies and procedures.
• Must have excellent time management, communication and organizational skills.
• Requires excellent diplomacy, oral and written communication skills as well as the ability to maintain strong working relationships with internal/external senior leadership teams, revenue cycle teams, facilities, physicians, physician reviewers, administrators, and assistants.
• Must be able to coordinate efforts among various departments at Point32Health and possess the ability to work well with others in a team environment.
• Responsible for timely responses on external and internal communication
• Requires the ability to conduct data analysis and create documentation on escalated issues

Working Conditions and Additional Requirements

• Set in a fast-paced office environment that requires handling multiple demands simultaneously.
• Must be able to exercise appropriate judgment in a fast paced environment.
• Requires the reading, preparation, interpretation, and assimilation of substantial amounts of data that is conveyed electronically and in hard copy, frequently in very large reports.
• Must be able to communicate effectively in both written and verbal formats including formal and informal presentations to groups.
• Must be able to attend provider meetings scheduled at various times including early morning and evening hours.
• The PAM II must be able to intermittently accommodate hours that precede or extend past the normal work day as business requires

Compensation & Total Rewards Overview

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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