Senior Manager, Reimbursement Policy

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ABOUT THE ROLE

The Senior Manager, Reimbursement Policy as part of the Finance team, will be a key contributor in building out the infrastructure to manage out-of- network negotiations along with building and running other reimbursement related processes. This position will play an integral role in driving the company’s financial performance by negotiating with out-of-network providers for services and/or treatments for Members when in-network options are unavailable. This position will be responsible for executing Single Case Agreements (“SCAs”) quickly and efficiently. You will memorialize and price services for our members to receive care from out-of-network providers, reach out and follow up to get these agreements signed, and upload the terms of the signed agreement to our claims team so that providers are paid timely and accurately. This position will be responsible for supporting Bright’s relationship development with key national and local network providers as well as for advancing reimbursement best practices and policies. 

YOUR RESPONSIBILITIES

  • Build, and own development and support the implementation of Bright Health’s new process for managing SCAs from start-to-finish, including but not limited to contract negotiation, execution, and implementation process oversight
  • Build, train, and manage high performing team to advance out-of-network workflows and reimbursement best practices and policies
  • Effectively negotiate rates and contract language with a range of provider types across multiple geographies through efficient cross-analysis
  • Manage and report weekly on SCA pended claims queue
  • Management and oversight to ensure key stakeholders and downstream vendors have access to data required to carry out operational processes (e.g. network management, finance, claims)
  • Collaborate with our Network Development team by identifying potential network providers through ongoing evaluation and analysis of data collected as a result of Single Case Agreements
  • Partner with stakeholders across the organization including but not limited to customer service, clinical, networks, provider relations and medical management to drive strategic priorities and initiatives
  • Monitor utilization/trends for non-participating providers and execute on organizational strategies to enhance provider networks

SUPERVISORY RESPONSIBILITIES

  • This position will have supervisory responsibilities for some members of the Reimbursement Policy Team

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • A Bachelor’s Degree in business, finance, healthcare administration, or a related field is preferred
  • A minimum of five (5) years of experience working in a managed care environment, preferably health plan
  • A minimum of seven (7) years of experience with successfully negotiating and executing payer-provider contracts
  • Experience in reimbursement policy or program management experience required
  • Experience in provider relations, provider servicing, claims processing, or any combination of education and experience which would provide an equivalent
  • Experience with developing, analyzing and presenting various types of financial and utilization data in order to make informed strategic decisions preferred
  • Experience in building and running a processes, a must
  • Coding and billing experience, preferred 

PROFESSIONAL COMPETENCIES

  • Desire and ability to move quickly between strategic leadership, tactical execution, and managing analytics
  • Knowledge of managed care practices and procedures, specifically in contracting language, terminology, and negotiations. Provider relations is preferred
  • Strong teaching and mentorship capabilities to support team members personal and professional development
  • Experience and strong influential skills to manage cross-functional, virtual teams
  • Ability to effectively engage with various provider types, ranging from national to local hospital, physician and ancillary
  • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures
  • Strong collaboration skills to work with internal and external teams to effectively design solutions that meet the business needs
  • Excellent multitasking and prioritization skills with a proven ability to manage multiple projects in parallel to completion
  • Superb written and verbal communication skills with an ability to effectively collaborate with internal and external executive leadership
  • Ability to perform multiple tasks and prioritize simultaneously

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: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing 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!

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Location

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.

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