Provider Account Manager

Tufts Health Plan Watertown, MA


Under the direction of the Supervisor, Provider Account Management, the Provider Account Manager functions as the primary point of contact for Commercial, Senior Products and Tufts Health Public Plans operations by provider assignment. These assignments include strategically important Tufts Health Plan business partners, such as IDNs, large facilities and/or physician organizations. In addition, the Provider Account Manager acts as a subject matter expert in provider relations working directly with the Contracting teams to resolve operational issues that could potentially interfere with the successful completion of the contracting cycle. The Provider Account Manager is expected to function with a high degree of autonomy while seeking guidance from management when appropriate. The Provider Account Manager works with internal and external business partners and is expected to represent Tufts Health Plan professionally at all times.

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance)

* Acts as the primary point of contact for complex operations 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 Tufts Health Plan 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.
* Requests provider reports on a regular basis or as needed 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.
* 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.
* Participates in various departmental initiatives, projects or committee meetings as assigned by management.
* Other duties as assigned by management.

EDUCATION: (Minimum education required)
* B.A. or B.S. or commensurate experience required.
* Master's degree in health care or business preferred.

EXPERIENCE: (Years of experience)
* 4-5 years work experience in health care or related field required.
* Computer skill required: Excel(advanced), Word, Power Point and Visio.
* Analytical skills a plus.
* Candidates must have strong and effective communication experience.

SKILL REQUIREMENTS: (Include interpersonal skills)
* 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 the ability to appropriately escalate issues. Excellent problem solving, team participation, and relationship building skills are essential.
* Requires comprehensive knowledge of Tufts Health Plan financial risk arrangements to identify problems and facilitate resolutions that will positively affect the health plan and the provider unit.
* Requires sound knowledge of all Tufts Health Plan 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 Tufts Health Plan and must possess the ability to work well with others in a team environment.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)
* Set in a fast-paced office environment that requires handling multiple demands simultaneously.
* Must be able to exercise appropriate judgment under stressful conditions.
* 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 Provider Account Manager must be able to intermittently accommodate hours that extend past the normal work day as business requires.
* Travel outside of the office is required.
* Valid drivers' license and access to an automobile for work meetings are required.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
 

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