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Provider Account Manager

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POST DATE 9/13/2016
END DATE 12/9/2016

Tufts Health Plan Watertown, MA

Watertown, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


Under the direction of the Manager, Provider Account Management and Education, the Provider Account Manager functions as the primary point of contact for Commercial and Senior Products operational issues for provider assignments. 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 Network Contracting & Performance Management Departments 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.

* Acts as the primary point of contact for 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 Tufts Health Plan and the provider site.
* Leading and facilitating regular internal and external meetings at the Provider sites (defining and developing agendas, keeping meetings on track, documenting and distributing meeting minutes and managing all follow-up tasks).
* Continuously monitoring the servicing model and making recommendations for changes/improvements as needed.
* Operational trendspotting and making recommendations for process development/ enhancement.
* Requests provider reports on a regular basis or as needed and conducts analysis of their findings. Reviews provider requests for large-dollar claim adjustments and documents proposals for settlement of claims for the review and approval of department management. The Provider Account Manager is responsible for operationalizing approved claim adjustments.
* Maintains documentation to include issues logs, status reports, all 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, Word, Power Point and Visio.
* Advanced Excel/ 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 issues 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, 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 oral formats including formal and informal presentations to groups.
* Must be able to attend provider meetings scheduled at various times including very early morning and evening hours.
* Work hours may extend beyond the normal business hours and the Provider Account Manager must be able to accommodate these hours.
* 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


Founded in 1979 as a non-profit health maintenance organization (HMO), Tufts Health Plan is one the country's largest HMO offering a full array of healthcare coverage options to individual consumers and employer groups. Tufts Health Plan has received high marks for its quality from a variety of third parties including U.S News & World Report and Newsweek.