Provider Account Manager II

About the role

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 . Job Summary 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. While all the job requirements for PAM II role are applicable to this role, there will be some modifications based on the type of providers and their specific needs. This position will work to ensure appropriate onboarding and ongoing education in addition to description below. 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 Job Description Key Responsibilities/Duties - what you will be doing (top five): 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. Qualifications - what you need to perform the job Certification and Licensure Education Required (minimum): bachelor's degree Preferred: master's degree Experience (minimum years required): Required (minimum): 3-5 years of professional experience. Preferred: 3-5 years of work experience in health care (including claims, customer service, or billing/ revenue cycle. Computer skills required: 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 Skill Requirements 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