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 (https://www.point32health.org/) .
Job Summary
Reporting to the Manager of Provider Relations, the Provider Account Manager (PAM) I plays a critical role in the management and engagement of providers in the Point32Health family of company's provider network and will act as a point of contact for participating providers. This role will play a key part in the facilitation of issue resolution, tracking, and trending concerns from the provider network. The PAM I will work collaboratively with other business areas within the enterprise facilitate the resolution of issues brought forth by providers. These issues could include (but are not limited to) claims, payment policies, process, and product participation. The PAM I may or may not have an assigned provider territory that could include hospitals, allied practitioners, and other provider groups as necessary. The PAM I is expected to function with autonomy while seeking guidance from management when appropriate. This individual collaborates with internal and external business partners to provide information and analysis related to complex healthcare operations, as well as coordinating with the PAM II on claims research.
Job Description
Key Responsibilities/Duties:
Maintain and document provider inquiries and conducts analysis of findings.
Reviews provider requests for large dollar claim adjustments and documents proposals for settlement of claims for the review and approval of department management; as appropriate, conducts root cause analysis and shares findings with internal/external audiences.
Maintains documentation including issue logs, status reports, correspondence, meeting agendas, meeting minutes, and any other pertinent provider documentation. Develops and delivers level-appropriate status reports/updates.
Conducts research on claims inquiries assigned by management. Issues that could be researched may include claims denied for no authorization, claims retracted in an audit, determine if claims were processed correctly per guidelines/contracts
Provide insights and assistance for the development of business reports that outline root cause analysis for issues that impact our provider network.
Communicate the results of data analysis in written and verbal form to managers
Participates in various departmental initiatives, projects or committee meetings as assigned by management.
Reply to external and internal communication on provider issues in a timely fashion
Other duties and projects as assigned.
Qualifications:
Education
Required (minimum): Bachelor's degree in a related field
Preferred: master's degree
Experience
Required (minimum): 3-5 years of professional experience
Preferred: 5-7 years of experience in health care, (including claims, customer service, billing/ revenue cycle.
Skill Requirements
Advanced Excel & SharePoint skills preferred, but willing to train
Proficiency in other Microsoft Office platforms (Word, PowerPoint, Visio, Outlook, etc)
Demonstrated ability to manage time and prioritize projects to meet deadlines
Strong written and verbal communication skills
Excellent critical thinking skills
Must be able to coordinate efforts among various departments at Point32Health and possess the ability to work well with others in a team environment.
Working Conditions and Additional Requirements:
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.
Disclaimer
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
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 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
For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
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.
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 TA_operations@point32health.org
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 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.
