Senior Manager, Reimbursement Policy at Bright Health

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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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Technology we use

  • Engineering
  • Product
    • .NETLanguages
    • C#Languages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • ScalaLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • ReduxLibraries
    • FlutterLibraries
    • ExpressFrameworks
    • Node.jsFrameworks
    • MongoDBDatabases
    • MySQLDatabases
    • PostgreSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • JIRAManagement
    • Microsoft ProjectManagement

Location

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.
Making Healthcare Better For All At Bright Health
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An Insider's view of Bright Health

What’s the vibe like in the office?

The office has a relaxed and laid back vibe but people are very serious about their work - perfect!

Anthony

Data Engineer

What does your typical day look like?

My day is so varied, given how quickly we're growing, which is fulfilling for me. I have a good balance of strategic and tactical work in my day as well as time to focus and time to collaborate.

Jen

VP, Digital

What makes someone successful on your team?

A hard-working team player who thinks first and codes next is likely to learn a lot and quickly become a valuable member of the team. Lots of experience with some of our tooling is always nice, but if someone can't knowledge-share well or responds poorly to code reviews and other requests for collaboration, it'll be a tough fit.

Brian

Software Engineer 3

How do your team's ideas influence the company's direction?

We hire smart individuals who thrive on accomplishment and purpose. Our teams are exposed to the bigger picture through constant communication and dialogues – that encourages them to come up with innovative solutions to problems. We've made significant adjustments on our direction in technology and process that were initiated by the team.

Abdullah

VP, Engineering

What are Bright Health Perks + Benefits

Bright Health Benefits Overview

We have 3 different health insurance plans, all through Cigna (HDP, Premium HDP and PPO). We cover the majority of the cost for the employee and some cost for family. We have two dental plans and a vision plan as well. We put 3% of your total earnings into your 401K plan and you are immediately vested in that. We have all the latest technology (Mac or Surface laptops – your choice) to use including standing desks. Fully stocked fridge with snacks and drinks.

Culture
Volunteer in local community
Partners with Nonprofits
Bright Health, is proud to be a founding partner of the Healthy Living Coalition addressing global nutrition and food insecurity.
Friends outside of work
Eat lunch together
Daily stand up
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Highly diverse management team
Unconscious bias training
Diversity manifesto
Mean gender pay gap below 10%
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Bright Health employees can contribute up to $3500 annually to their FSA.
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Wellness Programs
Bright Health is proud to offer a wellness stipend of $200/month to all employees!
Onsite Gym
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
We will put 3% of your total earnings into your 401K plan, even if you don't put anything in. It's a safe harbor contribution.
401(K) Matching
Bright Health provides employees with a 401(k) plan managed by Vanguard. We provide a ‘safe harbor’ non-elective contribution equal to 3% of your compensation, regardless of participation in the p
Company Equity
Performance Bonus
Child Care & Parental Leave Benefits
Child Care Benefits
Generous Parental Leave
We provide up to 6 weeks of parental leave for the primary caretaker. We also provide 2 weeks of leave for the secondary caretaker.
Flexible Work Schedule
Bright Health provides employees with a flexible work schedule that includes Core hours, Flexible start and end times.
Family Medical Leave
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Relocation Assistance
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Home Office Stipend for Remote Employees
Professional Development Benefits
Diversity Program
Lunch and learns
Promote from within
Time allotted for learning
Customized development tracks

Additional Perks + Benefits

Bright's primary goal is to offer employee benefits and perks that are as flexible as possible to meet each employee's unique needs!

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