Provider Relations Account Specialist

2 weeks ago

Canton, Massachusetts, United States Point32Health Full time

About Us

Point32Health stands as a premier organization in health and wellness, dedicated to enhancing the personalized healthcare journey for individuals within our communities. Building on the esteemed legacy of our founding entities, Tufts Health Plan and Harvard Pilgrim Health Care, we utilize our extensive experience to empower individuals in achieving their unique health aspirations through a diverse array of health plans and resources designed to simplify the navigation of health and wellness.

We take pride in the meaningful contributions we make daily in support of our members, partners, colleagues, and the broader community. To discover more about Point32Health, please explore our resources.

Position Overview

Under the guidance of the Manager of Provider Relations, the Provider Relations Account Specialist I plays an essential role in managing and engaging with providers within the Point32Health network. This position serves as a primary contact for participating providers, facilitating the resolution of issues and addressing concerns that arise within the provider network. The Specialist I collaborates closely with fellow Provider Account Managers and various business units to effectively resolve provider-related inquiries, which may encompass claims, payment policies, processes, and product participation. The Specialist may have an assigned territory that includes hospitals, allied practitioners, and other provider groups as necessary.

The Specialist I is expected to operate with a level of independence while seeking managerial guidance when needed. This role involves collaboration with both internal and external partners to provide insights and analysis related to complex healthcare operations, as well as coordinating with the Specialist II on claims investigations.

Key Responsibilities

  • Document and maintain records of provider inquiries while conducting thorough analyses of findings.
  • Review provider requests for significant claim adjustments and prepare proposals for management's review and approval; conduct root cause analyses and share findings with relevant audiences.
  • Maintain comprehensive documentation, including issue logs, status reports, correspondence, meeting agendas, and minutes, as well as any other relevant provider documentation.
  • Conduct research on claims inquiries assigned by management, which may involve denied claims due to lack of authorization, claims retracted during audits, and verification of claims processing in accordance with guidelines and contracts.
  • Provide insights and support for the creation of business reports that detail root cause analyses for issues affecting our provider network.
  • Communicate the outcomes of data analyses in both written and verbal formats to management.
  • Participate in various departmental initiatives, projects, or committee meetings as assigned by management.
  • Respond promptly to internal and external communications regarding provider issues.
  • Perform additional duties and projects as assigned.

Qualifications

Education: Associate's or Bachelor's degree, or equivalent experience preferred.

Experience: A minimum of 3 years of experience in healthcare, particularly in claims, customer service, or billing/revenue cycle is preferred.

Skills:

  • Proficiency in advanced Excel and SharePoint is preferred, though training is available.
  • Competence in other Microsoft Office applications (Word, PowerPoint, Visio, Outlook, etc.).
  • Demonstrated ability to manage time effectively and prioritize tasks to meet deadlines.
  • Strong written and verbal communication skills.
  • Excellent critical thinking abilities.
  • Capability to coordinate efforts across various departments at Point32Health and work collaboratively within a team environment.

Working Conditions

Must be able to work in a standard office environment and may work from home as required. The role may involve simultaneous use of a telephone/headset and PC/keyboard, as well as prolonged periods of sitting. Occasional travel within New England may be necessary, and additional hours beyond the standard work schedule may be required.

Compensation Overview

The salary range for this position is between $64,354 and $83,282. The actual salary will be determined based on various factors, including the complexity of the role, the candidate's skills, education, training, credentials, and experience, as well as internal equity and other employment conditions.

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is dedicated to integrating diversity, equity, inclusion, accessibility, and health equity into all aspects of our operations, from product design to workforce engagement. Our DEIA and Health Equity strategy aligns with our core values and adapts to the evolving nature of work. 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.

  • Client Relations Specialist

    1 week ago

    Canton, Massachusetts, United States New England Life Care Full time

    Job OverviewNew England Life Care (NELC) stands as a leader in home infusion therapy within New England, being the only non-profit provider in the region. Established by local hospitals, NELC is dedicated to ensuring that patients receive care that aligns with the highest standards of excellence in healthcare delivery.At NELC, we are committed to fostering a...

  • Senior Accounting Specialist

    1 week ago

    Canton, Massachusetts, United States DXL Group Full time

    At DXL Group, we prioritize finding the right match for our team. Our commitment to employee development is reflected in our training programs and our philosophy of promoting from within. We are a dynamic team dedicated to providing a unique experience that allows Big + Tall individuals to express their style freely.Every team member has a voice and the...

  • Senior Accounting Specialist

    2 weeks ago

    Canton, Massachusetts, United States DXL Group Full time

    At DXL Group, we prioritize finding the right match for our team members. Our commitment to employee development is reflected in our extensive training programs and our philosophy of promoting from within. We are a dynamic team dedicated to providing a unique experience that allows Big + Tall individuals to express their style freely.Every team member has a...

  • Senior Accounting Specialist

    1 week ago

    Canton, Massachusetts, United States DXL Group Full time

    At DXL Group, we prioritize finding the right match for our team. Our commitment to our employees includes comprehensive training and development programs, fostering a culture where anyone can lead and grow. We are a dynamic team dedicated to providing a unique experience that allows Big + Tall individuals to express their style freely.Every team member is...

  • Healthcare Provider Enrollment Specialist

    1 week ago

    Canton, Massachusetts, United States Point32Health Full time

    About the RoleAt Point32Health, we are seeking a skilled Healthcare Provider Enrollment Specialist to join our team. As a key member of our organization, you will play a critical role in ensuring the accuracy and integrity of our provider data systems.Key ResponsibilitiesAssess and validate contract and supporting documents for provider data entry.Collect...

  • Account Services Associate Specialist

    1 day ago

    Canton, Massachusetts, United States TalentBurst Full time

    Job SummaryTalentBurst is seeking a highly skilled Account Services Associate Specialist to provide administrative support for routine back-office tasks. The ideal candidate will have extensive proficiency in customer service and be able to handle situations that require adaptation of response or extensive research.Key ResponsibilitiesProvide administrative...

  • Virtual Client Services Account Representative

    1 week ago

    Canton, Massachusetts, United States Organogenesis Full time

    Remote Customer Service Account SpecialistCompany: OrganogenesisJob Category: Customer ServiceAt Organogenesis, we are committed to fostering exceptional talent and providing unique career opportunities. Join our team where you can grow both professionally and personally while contributing to our mission of Empowering Healing. We offer a comprehensive...

  • Client Relations Specialist

    2 weeks ago

    Canton, Massachusetts, United States Dunkin' Full time

    Dunkin', a proud member of the Inspire Brands family, stands as one of the most recognized quick-service restaurant brands globally, boasting over 12,000 franchised locations. Renowned for our premium coffees, espresso drinks, baked goods, and all-day breakfast sandwiches, we are committed to delivering swift and friendly service.Imagine a workplace where...

  • Sales Support Specialist

    2 weeks ago

    Canton, Massachusetts, United States Del Monte Fresh Produce Company NA Inc Full time

    Job OverviewPosition Objective:The Sales Support Specialist plays a crucial role in assisting the Sales Department by delivering exceptional customer service and operational support. This position involves addressing sales-related inquiries, processing new orders, tracking shipments, and managing customer accounts. The specialist will ensure that all credits...

  • Environmental Field Testing Specialist

    4 days ago

    Canton, Massachusetts, United States Alliance Technical Group Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Environmental Field Testing Specialist to join our team at Alliance Technical Group. As an Environmental Field Testing Specialist, you will play a critical role in conducting stack emissions testing, equipment preparation, deployment, staging/breakdown, sample collection, and recovery.Key...

  • Project Coordination Specialist

    2 weeks ago

    Canton, Massachusetts, United States Sika Full time

    The Project Coordination Specialist will oversee the complete lifecycle of customer purchase orders for Sika Roofing products and services, ensuring seamless processing, shipment, and fulfillment. This role is pivotal in delivering exceptional customer service, functioning as both an account manager and project manager for our esteemed clientele....

  • Staff Accountant

    5 days ago

    Canton, Massachusetts, United States DXL Group Full time

    About the RoleWe're seeking a highly skilled and detail-oriented Staff Accountant to join our Finance Team at DXL Group. As a key member of our team, you will be responsible for ensuring the accuracy and compliance of our financial records.Key ResponsibilitiesFinancial Reporting: Prepare and review financial statements, including balance sheets, income...

  • IT Support Specialist II

    2 weeks ago

    Canton, Massachusetts, United States Westinghouse Electric Company Full time

    IT Support Specialist II - Contract to PermanentLocation: Jefferson, LAAre you passionate about contributing to a forward-thinking organization dedicated to delivering sustainable energy solutions? At Westinghouse Electric Company, we value our workforce as our greatest asset and are committed to attracting and retaining top talent while fostering an...

  • Parts Supply Specialist

    1 week ago

    Canton, Massachusetts, United States FM Generator Full time

    Overview:The Parts Supply Specialist plays a crucial role in the Parts Department by ensuring effective procurement and distribution of all necessary components to the operational teams. This position is vital for achieving the company's profitability targets, maintaining service timelines, and upholding organizational standards while fostering customer...

  • Parts Logistics Specialist

    1 week ago

    Canton, Massachusetts, United States FM Generator Full time

    Overview:The Parts Logistics Specialist plays a crucial role in the Parts Department by ensuring the effective procurement and distribution of components to support operational efficiency and customer satisfaction. This position is vital for achieving organizational profitability and service delivery goals.Key Responsibilities:Reporting to the Parts Manager,...

  • Life Safety Specialist

    5 days ago

    Canton, Massachusetts, United States Hebrew SeniorLife Full time

    Job Summary:We are seeking a highly skilled and dedicated Life Safety Specialist to join our team at Hebrew SeniorLife. As a Life Safety Specialist, you will be responsible for ensuring the safety and well-being of our residents and guests in the pool area.Key Responsibilities:Conduct regular surveillance of the pool and surrounding area to identify...

  • Account Sales Executive

    1 week ago

    Canton, Massachusetts, United States Martignetti Companies Full time

    Job OverviewPosition Summary: The Sales Representative is accountable for driving all sales initiatives and achieving targets within designated accounts. This role involves cultivating business relationships with assigned clients and overseeing the execution of marketing and promotional activities. A Sales Representative acts as a business leader and...

  • Meat Science Specialist

    2 weeks ago

    Canton, Massachusetts, United States Robert Reiser & Co, Inc. Full time

    Job OverviewPosition: Meat Science SpecialistOverview: We are seeking a knowledgeable professional in the field of meat science to contribute to our operations at Robert Reiser & Co, Inc. This role involves applying expertise in meat technology to enhance product quality and safety.Key Responsibilities:Conduct research and development to improve meat...

  • Parts Logistics Specialist

    1 week ago

    Canton, Massachusetts, United States FM Generator Full time

    Overview:The Parts Logistics Specialist plays a crucial role in the Parts Department by overseeing the effective procurement and distribution of components to ensure the achievement of organizational profitability targets, service timelines, and operational goals while fostering reliability and enhancing customer satisfaction.Key Responsibilities:Reporting...

  • Fire Installation Specialist

    4 days ago

    Canton, Massachusetts, United States Johnson Controls International Full time

    Job Summary:Johnson Controls International is seeking a highly skilled Fire Installation Specialist to join our team. As a Fire Installation Specialist, you will be responsible for the execution of installation project plans, including equipment delivery and interface with other trades to successfully complete projects while exceeding customer...