Who We Are

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

Respond to provider queries, enter administrative authorization data into the computer system, and maintain proper documentation and files to support care of members, customer service, and other departmental functions. Enters all referral/data information into the computer system, maintains proper documentation and facilitates coordination of services. The position will be directly associated with incoming referrals and authorizations for the utilization component of medical management.

Job Description

Key Responsibilities/Duties – what you will be doing:

Receives incoming authorization requests from providers, via fax, portal & telephone to create an event or transaction by lines of business for the UM teams to review and decision requests
Contacts provider offices for further details on clinical information.
Research member eligibility and primary care selection to complete entry of the event.
Documents and maintains all telephone calls and enters a note on each call/inquiry made. Documents all admissions, and referrals. Maintains flow and storage of information such as messages, forms, and logs.
Works with providers and other members to solve complex and urgent issues. Ensures that appropriate person/department from across the organization is appropriately involved with applicable issues.
Data entry of Authorization Requests for all Inpatient stays – Outpatient requests as needed, into information system.
Represents Medical Management at applicable activities including system user groups and other health data system organizations.
Attends organization-wide meetings and department staff meetings.
Maintains professional growth and development through self-directed learning activities and involvement in professional, civic and community organizations.
Other duties as assigned by the Intake and Outreach Coordination leadership.

Qualifications – what you need to perform the job

Certification and Licensure

Education

Required (minimum): Associates’ degree or equivalent relevant work experience.
Preferred:

Experience

Required (minimum): Two plus years of experience in a business environment
Preferred: Managed care/health industry environment experience.

Skill Requirements

Exhibits exceptional internal and external customer service skills.
Ability to work in clinical and company databases
Excellent verbal and written communication skills generally acquired through college or other advanced education are required.
Must be able to demonstrate proficiency and accuracy in performing data entry tasks in multiple applications
Individuals must be able to appropriately identify urgent situations and follow the appropriate protocol.
Position also requires the ability to manage multiple priorities as well as having the initiative, judgment, and perception to operate independently and in a partnership with other departments.
Individuals must possess strong organizational and problem-solving skills and the attention to detail necessary to act within this complex environment.
Requires excellent interpersonal skills.
Position requires daily contact, by telephone, with network providers and their office staff, hospital contacts and Point32Health internal departments.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

Fast paced office environment handling multiple demands.
Must be able to exercise appropriate judgment, as necessary.
Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$19.73 -$29.59

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all
All applicants are welcome and 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.

Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org

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