Reporting to the Manager, 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, acting as a point of contact for participating providers. This role will play a key part in the facilitation of issues resolution, tracking, and trending concerns from the provider network. The PAM I will work collaboratively with other Provider Account Managers as well as 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 a of 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.

 

Key Responsibilities/Duties – what you will be doing

• 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 – what you need to perform the job

Education, Certification and Licensure

• Associates of Bachelor’s degree, or commensurate experience preferred

Experience (minimum years required):

• 3 years’ work experience in health care, (including claims, customer service, billing/ revenue cycle preferred).

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 (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.

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.

This job has been posted by IgnyteAI on behalf of Point32Health. IgnyteAI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of IgnyteAI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law

Req ID: R7587