Provider Account Manager I

Company: TalentBoost (Point32Health)
Location: Brookline
Posted on: November 26, 2022

Job Description:

This role is primarily designed for, but not limited to, supporting selected providers in the Point32Health network. The person in this position will work closely with other members of the Provider Account Management team to provide research on claims and operational inquiries to their provider assignments. These assignments include strategically important Point32Health business partners, such as IDNs, large facilities and/or physician organizations.
The PAM 1 is expected to function with a high degree 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 2 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
• Create business reports that provide insight into root cause analysis
• 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 as assigned by management. -Qualifications - what you need to perform the job
  • B.A. or B.S. or commensurate experience required
  • 4-5 years' work experience in health care, claims operations or billing/ revenue cycle required.
  • Computer skill required: Excel (advanced), Word, Power Point and Visio.
  • Analytical skills that allow for the development of data-driven reports
  • 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 exercise appropriate judgement in complex situations that may involve multiple priorities and or escalation - including timely identification/reporting of escalations.
    • Requires the reading, preparation, interpretation, and assimilation of substantial amounts of data that is conveyed electronically and in hard copy, frequently in very large reports.
    • Must be able to communicate effectively in both written and verbal formats including formal and informal presentations to groups.
    • Must be able to attend provider meetings scheduled at various times including early morning and evening hours.
    • The PAM 1 must be able to intermittently accommodate hours that precede or extend past the normal work day as business requires.
    • Travel outside of the office is required.
    • Valid drivers' license and access to appropriate transportation for work meetings are required. -Commitment to Diversity, Equity & InclusionPoint32Health is committed to making diversity, equity, and inclusion part of everything we do-from product design to the workforce driving that innovation. Our DEI 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. -COVID PolicyPlease note: As of January 18, 2022, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law. -About the CompanyPoint32Health 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 TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost 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: R5382

Keywords: TalentBoost (Point32Health), Brookline , Provider Account Manager I, Executive , Brookline, Massachusetts