Provider Account Manager II

Who We ArePoint32Health 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 SummaryReporting to the Manager, Provider Relations, the Provider Account Manager (PAM) II plays a critical role in the strategic management and engagement of providers in the Point32Health family of company’s provider network, acting as the primary point of contact for the assigned providers. This role will provide dedicated support to Long Term Support Service (LTSS) providers that typically provide services to members in our Duals products. While all the job requirements for PAM II role are applicable to this role, there will be some modifications based on the type of providers and their specific needs. This position will work to ensure appropriate onboarding and ongoing education in addition to description below. This highly visible role will play a critical role in developing and maintaining key provider relationships while serving as the primary point of contact for resolving escalated provider issues that may impact provider satisfaction and/or overall Point32Health business strategy. The individual will act as a liaison promoting mutually positive relationships through coordination and collaboration the provider network, and vended partners across the multi-state delivery and enterprise systems. The PAM II is expected to function with a high degree autonomy, while both seeking and providing guidance to resolve complex issues. Role responsibilities include the coordination of Point32Health’s provider related constituent relationships, escalated issues management and engagement of their assigned provider territory. The PAM II collaborates with external and internal cross-functional resources to ensure the needs of the provider network are met, including timely resolution of issues. This individual will interact directly with provider organizations and will serve as a subject matter expert providing consultative services internally with other key stakeholders such as claims, contracting, call center, product, and other teams as neededJob DescriptionKey Responsibilities/Duties – what you will be doing (top five):Acts as the primary point of contact for assigned providersTracks and trends 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 and projects as assigned.Qualifications – what you need to perform the jobCertification and LicensureEducationRequired (minimum): bachelor’s degreePreferred: master’s degreeExperience (minimum years required):Required (minimum): 3-5 years of professional experience.Preferred: 3-5 years of work experience in health care (including claims, customer service, or billing/ revenue cycle.Computer skills required: Excel (advanced), Word, Power Point and Visio.Strong presentation skills requiredStrong project management skills requiredCandidates must have strong and effective communication skills and experience – both verbal and in writingSkill RequirementsRequires 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 solutionsRequires 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 communicationRequires the ability to conduct data analysis and create documentation on escalated issuesWorking Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):Must be able to work under normal office conditions and work from home as required.Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.Some travel within New England could be requiredMay be required to work additional hours beyond standard work schedule.DisclaimerThe above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.Salary Range$70,677.38 -$106,016.08Compensation & Total Rewards OverviewThe annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:Medical, dental and vision coverageRetirement plansPaid time offEmployer-paid life and disability insurance with additional buy-up coverage optionsTuition programWell-being benefitsFull suite of benefits to support career development, individual & family health, and financial healthFor more details on our total rewards programs, visit welcome allAll 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.Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact View email address on click.appcast.io #J-18808-Ljbffr Point32Health