The Senior Director - Reimbursement Policy is responsible for identifying, prioritizing and implementing Bright Health Plan reimbursement policies in support our Commercial (Individual and Family Plan and Employer) and Medicare Advantage lines of business. You are responsible for leading a team of cross-functional senior leaders who will provide input on potential policies and support for implementing policies based on their respective areas of expertise (e.g. clinical, legal and compliance, Care Partner relationships, operations, etc.). You will develop a process to continuously analyze market changes and respond quickly to regulatory requirements along with developing a governance structure needed to approve, implement and measure the results of the policies being implemented.
The Senior Director - Reimbursement Policy is a critical member of the Bright Health Plan Finance team directly supported by a small team. This role is accountable for supporting the company’s performance by developing our reimbursement policy strategy that also supports the advancement of Bright’s relationship with our Care Partners, network partners, aligned providers and members.
The successful candidate will be a self-starter and will have a proven track record of succeeding in fast-paced and complex health care settings. You anticipate how changes to reimbursement policy will impact both external and internal stakeholders and will proactively optimize solutions. You lead with accountability; are an excellent verbal and written communicator; operate with strong attention to detail. Your colleagues and clients recognize you for leading through influence, having empathy towards others, being highly collaborative and strongly exhibit ability to drive towards measurable outcomes.
- Build and grow the reimbursement policy team, including program manager and medical economics analyst
- Set goals for incremental improvement in reimbursement policy outcomes that align with Bright Health annual goals
- Perform competitive analysis to ensure Bright Health reimbursement policies are advancing in line with marketplace trends
- Monitor regulatory guidance to ensure Bright Health reimbursement policies reflect changes in a timely manner
- Collaborate with senior leaders of key functional areas (network, claims, legal and compliance) to ensure appropriate input and implementation plans are built and deadlines are met
- Oversee cross-functional implementation plans to ensure end-to-end implementation is a success
- Prioritize reimbursement policy priorities based on financial impact, ease of administration/implementation, regulatory requirements, etc.
- Communicate reimbursement policy changes in both formal written policies and through internal and external communication vehicles (e.g. our website)
- Measure outcomes of reimbursement policy changes including financial impact and provider and member feedback
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree or equivalent work experience required.
- Ten (10) or more years’ reimbursement policy or program management experience required
- Seven (7) or more years of experience in Healthcare field required
- Advanced proficiency with Microsoft Excel and Microsoft Power Point required
- Advanced knowledge of MS Project, MS Visio and/or LucidCharts preferred
- Previous health care experience, preferably in one of more of the following areas: provider systems or health plans
- Strong collaboration skills to work with internal and external teams to effectively design solutions that meet the business needs
- Experience and strong influential skills to manage cross-functional, virtual teams
- Excellent written and verbal communication skills
- Ability to understand and identify regulatory and implementation risks and develop mitigation strategies
- Ability to perform multiple tasks and prioritize simultaneously
- Ability to perform critical analysis of complex policy implementations
- Ability to effectively engage and interact with and influence internal executive sponsors
- Advanced time management, project management, and analytical skills
- High attention to detail
- Strong analytical skills, work ethic, problem solving ability, and overall positive attitude
- Demonstrated flexibility, organization, and self-motivation
- Adaptable to change
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.