Provider Account Manager II

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

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

Job Summary

Reporting 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 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 needed

Key Responsibilities/Duties – what you will be doing

• Acts as the primary point of contact for assigned providers
• Tracks 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 job

Education, Certification and Licensure

• Bachelor’s degree, or commensurate experience preferred
• .

Experience (minimum years required):

• 4-5 years’ work experience in health care (including claims, customer service, or billing/ revenue cycle preferred.
• 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

Skill Requirements

• 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 (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 required
• May be required to work additional hours beyond standard work schedule.

The 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.

Compensation & Total Rewards Overview

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who 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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