Account Specialist

Mass General Brigham•Somerville, MA

10d•Remote

About The Position

The Account Specialist is responsible for supporting the Account Managers in their efforts to resolve a wide variety of contractual, operational, and strategic issues as quickly and efficiently as possible. Through the Account Managers, the Account Specialist will help implement network-wide strategic initiatives throughout the MGB CP Network to enhance their organizational, operational, and financial effectiveness. The Account Specialist will work closely with MGB CP, PHSO, OCMO, external payers and other internal and external resources to facilitate a successful and timely resolution to issues that require additional research and have been escalated by the Account Managers, RSO leadership and practices within the CP. The Account Specialist builds a strong relationship internally and externally to help support the Account Managers.

Requirements

Bachelors Degree in finance preferred
Equivalent experience may be accepted in lieu of degree
2+ years of back-office healthcare industry experience, with increasing responsibilities and autonomy.
2+ years of experience in a healthcare setting, such as a Management Services Organization (MSO), a Physician Hospital Organization (PHO) or a health plan strongly preferred
Position requires a high level of judgment, creative problem solving, independence, comfort, and experience with interfacing with Manager and Director level staff.
Experience in working within a team is critical.
Knowledge and understanding of the healthcare industry, including but not limited to medical management, financial, operational and organizational components.
Able to synthesize data from multiple sources, identify trends and key issues from the data, and deliver a succinct message to RSO and MGB CP leadership.
Strong understanding of payer operations.
Basic understanding of finance and accounting principles with the ability to understand various fund flow models.
Ability to simultaneously handle a variety of complex issues.
Ability to work collaboratively within a team environment.
Navigate within a highly matrixed organization.
Recognize politically sensitive issues yet remain effective at the task at hand.
Know when and how to escalate issues.
Strong judgment and discretion skills.
Skillful in analyzing situations accurately and taking effective action.
Skillful in establishing and maintaining effective working relationships with MGB CP, PHM, OCMO, RSO and Practice leadership.
Organized and able to manage and prioritize multiple projects with competing priorities, often with little direct supervision or initial guidance.
Must have ability to adapt to changing environment.
Understanding of the functions and uses of database management systems.
Intermediate to advanced skills with Microsoft Excel, Access, PowerPoint, and Word.
Excellent oral and written communications skills, with the ability to effectively analyze and interpret complex data.
Willingness to travel to practices as needed.
Access to a vehicle and a valid driver’s license is required.

Responsibilities

Alongside the Account Manager, serve as a liaison and a bi-directional channel of communication between leadership at MGB CP, community RSOs, AMCs, and PHSO/OCMO.
Act as an RSO voice within MGB CP to promote community interests, raising critical issues to the Account Manager to address and help support successful resolutions.
Develop new relationships and enhance existing ones internally at MGB as well as externally.
Support distinct needs of the affiliate practices.
Attend RSO meetings as appropriate.
Build relationships with MGB Contracting, RCO as well as external payors to ensure timely responses to RSOs need.
Escalate and troubleshoot payer-related policies, contractual, operational, and technical issues by working collaboratively with internal MGB departments, such as Contracting, Finance, and Provider Enrollment.
Assist in researching and resolving: Payer claim payment issues, Benefit and copayment questions, Balance billing issues, Supplemental payment questions.
Summarize payer-related issues that need to be escalated and discussed at Payer Operation meetings.
Focus on operational effectiveness.
Provide general behind the scenes support to RSOs on IPF related issues.
Maintain full knowledge of IPF measures, including an understanding of the measures.
Maintain a general understanding of the differences between payers and products.
Maintain Account Management Grid.
Help distribute reports to the RSO/practices as needed.
Maintain accurate and up-to-date documentation of practice and provider information across all internal systems.
Prepare and distribute regular status updates and reports on payer enrollment progress and provider onboarding.
Works closely with the RCO enrollment team to onboard and offboard MGB CP direct affiliates.
Collects completed paperwork.
Acts as a conduit to provider enrollment.
Monitor payer enrollment timelines and escalate delays or issues when needed to ensure timely provider activation.
Support various MGB CP led meetings by: Scheduling, Help setting agenda, Collecting presentations and creating the slide deck, Pre and post meetings with each of the teams, Keeping the meeting on schedule, Taking minutes.
Assist the Senior Medical Director on ad hoc requests.