ABOUT THE ROLE

Bright’s Senior Payment Integrity Analyst is responsible for executing a claim recovery strategy which includes the analysis of claims data for identifying cost containment opportunities both with internal and external partners. Our Payment Integrity Analysts also work to review and analyze recommendations for recovery found in waste and abuse recovery audits and plays an integral role in ensuring claim integrity as this position supports all recovery efforts for the Claims Operations team.

YOUR RESPONSIBILITIES

• Investigate, recover and resolve various types of claims as well as recovery and resolution
• Review recommendations for recovery to determine if it align with state and federal compliance policies, corporate reimbursement policies, contract compliance and regulatory codes as well as pre-authorizations and/or medical records
• Collaborate with Bright staff from various departments as well as external clients to ensure prompt and appropriate action is taken regarding cost avoidance/cost containment activities
• Responsible for working with our vendors to ensure any corrections, recommendations or issues are resolved properly and to satisfaction
• Monitor vendor files to ensure claim information and invoices are being submitted accurately and timely
• Analyze and identify trend recovery patterns to look for process improvement opportunities and submit recommendations in writing to internal customers and external vendors in which the reviews are being performed
• Manage and support various large projects
• Audit contracts to determine accuracy and validity of claims systems compared to agreements
• Work with contracting and configuration teams when inconsistencies are found
• Generate efficiencies around standard business processes and document processes as necessary

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree preferred; Seven (7) years relevant experience in lieu of a degree
• Five (5) or more years in healthcare claims, coding, recovery and/or claim auditing/analytic experience required
• Two (2) or more years’ experience in project management
• Background in Payment review of claims preferred

PROFESSIONAL COMPETENCIES

• Ideal candidates will have a strong understanding of healthcare, medical claim billing standards, recovery practices, as well as vendor management, operational functions and company operations
• Ability to manage multiple projects simultaneously and candidates will need strong organizational, analytical, and problem-solving skills
• You are very detail oriented
• You thrive in fast-paced environments and excel at creating structure and bringing operational rigor to teams
• You have a passion for creating an effective team environment and resolving conflicts
• You are self-directed and do a great job of prioritizing
• Like others on our team, you are humble, mature and check your ego at the door
• You are brave and always challenge the status quo but respectful and have an open mind
• You are excited to take ownership at early stage of company

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!