Sr. Director - Reimbursement Policy

| Remote
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.

YOUR RESPONSIBILITIES

  • 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

PROFESSIONAL COMPETENCIES

  • 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

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
    • JavascriptLanguages
    • PythonLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • Node.jsFrameworks
    • MongoDBDatabases
    • TSQLDatabases
    • 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.

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?

Our team works within an Agile framework with 2 week sprints. Tasks in my sprint that I tackle daily range from ideation, research, designing wires and mocks in Sketch, UI kit updates, prepping for an engineering handoff, etc.

Diane

Digital Product Designer

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

Full Stack Software Engineer

How do you make yourself accessible to the rest of the team?

Modeling after my manager, I like to provide both regularly scheduled one-on-one meetings, where developers and engineers get to set the agenda. We can talk about career development, design and architecture ideas, industry trends, or traditional HR topics like goal setting. It’s up to them. I also have begun setting regular “office hours.”

Amy

VP & Data Platform Architect

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 have an open PTO program. 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
Friends outside of work
Eat lunch together
Daily stand up
Open door policy
Team owned deliverables
Team based strategic planning
Pair programming
Open office floor plan
Diversity
Highly diverse management team
Mean gender pay gap below 10%
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
Onsite Gym
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
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
Employees who have been with the company for 12 months are eligible for 12 weeks of family medical leave.
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Unlimited Vacation Policy
Paid Holidays
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Parking
We offer employees a monthly parking subsidy.
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Professional Development Benefits
Promote from within
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