Provider Network Account Specialist at AllWays Health Partners in Somerville, Massachusetts

Posted in Other 4 days ago.

Job Description:

The Provider Network Account Specialist is responsible for the quality of execution of new provider setup and management, as new providers and provider groups enter the Allways Health Partners' provider network.

The Provider Network Account Specialist receives provider contract and enrollment documents from the Network Growth team and works collaboratively to validate that the provider is set up correctly. The Provider Network Account Specialist will ensure initial outreach to new provider(s), oversee onboarding and onsite education activities, and manage the ongoing interaction with the provider. The Provider Network Account Specialist acts as primary point of contact for designated providers and provider groups.

The Provider Network Account Specialist will serve as the subject matter expert for rapid and seamless onboarding and delighting new providers in the Allways Health Partners network. This position will be responsible for managing any ad-hoc project work, assessing project needs and work with PNM leadership to execute on deliverables, in support of ongoing provider satisfaction. This position will monitor and maintain the provider's input to the Portal with respect to roster entries and will troubleshoot provider issues, as they arise.

This position will be responsible for conducting provider orientation sessions, making educational visits, and work to resolve provider billing, claims and/or authorization issues. Represent Provider Network Management on relevant internal and external committees, task forces, and other bodies as required.

Essential Functions

The individual will own to closure all PR inquiries submitted via the SharePoint site or via email. Tasks will include:
• Generate fee schedules from Power BI Dashboard, customize file, and send to provider (or post in provider portal).
• Review general claim inquires, triage to claims department or appeals if needed.
• Submit any code inquiries to PPDIS via SharePoint and ensure the issue is closed and communicated to the provider.
• Troubleshoot Provider enrollment discrepancies/issues.
• Collaborate with Contracting, PEC, Clinical and other internal departments on basic issues that have been escalated.
• Triage all provider vendor related issues, work with internal vendor liaisons.
• Outreach to provider offices/groups to redirect all incoming general issues and to provide general education.
• Assist with the cleaning up of the PR SharePoint site and developing new Provider System Profiles.
• Keep Provider contacts up to date.
• Track and trend all inquiries submitted to Provider Network Account Executives via SharePoint and via email.
• Other duties as assigned.

The incumbent will advise management and serve as subject matter expert for process improvement, work streamlining, and best practices around technical communications to the network.

• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization.
• Other duties as assigned with or without accommodation.

Working Conditions and Physical Effort

• Work is normally performed in a typical office work environment.


Minimum Requirements
Knowledge and Education


• Associate's Degree or the equivalent combination of training and experience, plus 2 years of related experience.


• Bachelor's Degree



• 2 years of experience.


• 5 years of experience


• Demonstrate AllWays Health Partners' core brand principles of always listening, challenging conventions, and providing value.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

EEO Statement

Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.

The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.

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