“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is through powerful relationships with Care Partners, we help all people live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.

ABOUT THE ROLE

The Network team is responsible for partnering with our Care Partners to turn their provider networks into market leading integrated delivery systems. We are reimagining how the network development, network management, and provider relations functions can advance affordable, simple, and personal care for our members. The Senior Business Analyst, Network Cost Management will play an integral role in driving the company’s performance by optimizing contractual reimbursement terms and coding definitions of major agreement, as well as standardizing provider rate sheets. The Senior Business Analyst will support development and management of unit cost tools across all Bright Health Markets and Products. You will maintain contractual terms management solutions and renegotiations calendar for Bright Health’s major provider agreements.

YOUR RESPONSIBILITIES

• Optimize all contractual reimbursement terms across all agreements, including Care Partners
• The efforts will employ best practice in facility contracting terminology and reimbursement methods, to systematically identify and work with Network/Market development teams to recontract or correct outlier terms
• Analyze service definitions for our contractual agreements with Care Partners and other participating hospital systems with focus on standardizing coding across all provider agreements
• Partner with Bright Health Network and Clinical Management teams to optimize coding and produce cost savings
• Assess and standardize contractual terms and language across all provider agreements
• Partner with Legal, Product, Operations, Network and Market teams on the development and implementation terms and reimbursement methodologies to ensure alignment with plan design and claims operations
• Maintain a contract terms, reimbursement methodology and unit cost guidance management database across all major provider agreements
• Continuously work with Network leaders to recontract all adverse contractual terms and reimbursement provisions
• Collaborate with Markets and Care Partners to analyze, design, and develop reimbursement structures
• Maintain a contract renewal calendar with a timeline process for all major contract renegotiations
• Analyze and develop short-term and long-term best practices for contracting, including governing terms, reimbursement rates and structures, and template structure
• Partner across the Bright Health organization with Analytics, Actuarial, and Cost Containment areas on healthcare cost and pricing related initiatives

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• A Bachelor’s Degree in business, economics, healthcare administration, or a related field is required
• At least four (4) years of healthcare analytics experience, with at least one (2) years of experience in contract evaluation, medical cost containment, or reimbursement model design, is required
• Experience with Gov’t and proprietary payor reimbursement methodologies and unit cost management is required

PROFESSIONAL COMPETENCIES

• Desire and ability to move quickly between strategy, tactical execution, and analytics
• Ability to effectively engage providers, ranging from national providers to regional integrated delivery systems to local physician practices
• Excellent technical skills, including expert Microsoft Excel, and SQL or SAS skills
• Strong organizational design capabilities with the ability to creatively and strategically structure complex problems
• Bias toward action; sense of urgency, self-initiative, and ownership of work
• Superb written and verbal communication skills

ABOUT US

At Bright Health, we brought together the brightest minds from the health care industry and consumer technology, and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized, and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities, we are reshaping how people and physicians achieve better health together.

We’re Making Healthcare Right. Together. 

We've won some fun awards like Modern Healthcare and Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our team!

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

BRIGHT ON!