Provider Account Manager II

Point32Health • Canton, MA

21h • $70,677 - $106,016 • Hybrid

About The Position

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 role will provide dedicated support to Long Term Support Service (LTSS) providers that typically provide services to members in our Duals products. This position will work to ensure appropriate onboarding and ongoing education. 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.

Requirements

• Bachelor’s degree
• 3-5 years of professional experience.
• 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

Nice To Haves

• Master’s degree
• 3-5 years of work experience in health care (including claims, customer service, or billing/ revenue cycle.

Responsibilities

• 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.

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level