Program Manager III - Payment Integrity Audit at Point32Health, Inc. in Canton, Massachusetts

Job Description:

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

The Program Manager III will manage a specific vendor audit program with significant complexity, risk and/or savings opportunity. Initial key responsibilities will include implementation of the new program in one of our core systems. Responsibilities include successful implementation of a large cross-functional project to support Payment Integrity Audit capabilities, working closely with the appropriate Point32Health staff from multiple areas, working with an external vendor to validate opportunities and acquiring internal approvals, leading and/or representing program change initiatives that affect multiple departments. The Program Manager III evaluates the opportunities and develops recommendations for Payment Integrity leadership relative to the program and its objectives. This role will require facilitating cross-departmental meetings as well as participate in decisions with outside parties/partners and contacts. The Program Manager III will also interact directly and regularly with peers and leadership within the department and within Point32Health and others to accomplish successful program management.

Key Responsibilities/Duties - what you will be doing

Overall program ownership and management of key programs, focusing on both short-term initiatives and long-term strategic direction and objectives for the programs. The Program Manager III is responsible for:

• Management of cross-functional projects and initiatives


• Proactive and solutions-oriented management of program operations and integration issues, requiring the ability conceptualize and envision the impact of change, and propose new ways to do business to better meet the needs of the client/partner) and Point32Health


• Appling project management skills to ensure transparency, reporting, and successful projects. Maintain relationships both within department and with Point32Health leadership.


• Utilize project management expertise to ensure that workflows, processes, risks, communications, resources, and quality are managed appropriately within POINT32HEALTH to support the program and projects. The Program Manager III will determine program needs and will direct project management as needed. The Program Manager III will identify risks, concerns, or issues and escalate to management as appropriate. The individual will exercise judgment to make decisions and ensure programs/project is effectively progressing


• Lead regular cross functional informational or working meetings, including effective agenda planning, facilitation, and tracking/follow up on deliverables until closed. Meetings include, but not limited to, Business Stakeholders and Operations Working team.


• Other duties and projects as assigned.

Qualifications - what you need to perform the job

• 3 years of healthcare experience and experience in health care analysis preferred.


• BA/BS required


• Medical Coding experience preferred.


• Skilled at manipulating and analyzing large data sets.


• Knowledge of Tableau or other BI tools, SAS or other reporting tools (SAS, SQL, MicroStrategy, Cognos. Advanced use of MS tools, especially Excel.

• Business process and project/program management experience related to the implementation of healthcare insurance business applications.

• A proven ability to meet deadlines is also required.

Skill Requirements:

• Ability to work with and leverage leadership to resolve most roadblocks to program progress. Able to operate in a matrixed environment. May need to coordinate the participation of other internal contacts to develop and or maintain programs.


• Able to strategically navigate issues. Is an effective advocate for program and negotiates/leads others both internally and externally to participate in the program.


• Proactively identifies conflict/integration issues and leads team members to parse/synthesize issues of the highest complexity. Able to identify risk out of the larger picture and has a proven ability to accurately estimate and plan resource usage.


• The Program Manager III will be a SME for the specific program. Must be able to converse and lead dialogue on the subject with minimal direction.


• Ability to manage multiple projects simultaneously and to function independently.


• Ability to thrive in a matrix-management, hands-on fast paced environment that demands a consultative approach and solutions that span multiple environments in a business area.


• Outstanding communication and relationship management skills required, including the ability to effectively manage difficult group dynamics to effectively reach a positive outcome.


• Ability to interact with confidence with external vendors, and Leadership.


• Must be flexible and a proponent/champion of change, able to conceptualize and envision the impact of change, and propose new ways to do business.


• Strong verbal and written skills, ability to facilitate planning and review sessions with multiple levels, ability to develop and present program reports and high-level presentation skills.

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

• 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.


• May be required to work additional hours beyond standard work schedule.

Compensation & Total Rewards Overview

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/

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

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do-from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. 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.

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