Senior Provider Contract Specialist at Bright Health
- The Senior Provider Contract Specialist description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Lead the development of provider contracting efforts from start-to-finish, including but not limited to process oversight, strategic diligence, outreach, and contract negotiations with regards to mid-sized and large hospitals and health systems, large and small physician groups and ancillary providers to execution
- Effectively negotiate rates, structures, and contract language with a range of provider types across multiple geographies
- Support collaboration with our Care Partners to analyze, design, and develop networks through ongoing evaluation of both current and potential network participants
- Support and enhance Bright Health’s portfolio of strategic national and multi-regional network partnerships to compliment local network development efforts
- Manage ongoing network participation and performance, including performance analytics and management, as well as contract renewals and terminations
- Partner with stakeholders across the organization including, but not limited to sales, finance, regulatory, medical management to drive strategic priorities and initiatives
- Monitor utilization trends for non-participating providers and execute on organizational strategies to ensure members are seeking care with participating providers when appropriate
- Other duties and responsibilities as assigned
- This position does not have supervisory responsibilities.
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- A Bachelor's Degree in business, economics, healthcare administration, or a related field is preferred
- At least five (5) years of health plan or provider experience with three (3) years of network contracting with all lines of business
- Experience with successfully executing and implementing payer-provider contracts or partnerships required
- Experience with developing, presenting and analyzing various types of financial analyses in order to make informed strategic decisions preferred
- 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 and negotiations. Provider relations is preferred
- Ability to effectively engage providers, ranging from national providers to regional integrated delivery systems to local physician practices
- Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures
- 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
BEHAVIORAL AND LEADERSHIP NORMS
- Bright Values: Exemplifies Bright Values. Leads by example. Is viewed as key leader in the company. Acts with quiet, calm determination. Effectively influences inside of the organization.
- Decision making: Has a strong voice and is a contributor in the decision-making process. Is sought out in the organization for input in driving to a decision. Makes decisions based on fact. Is capable of taking large sums of information, and drilling into what is important. Understands organizational impact of decisions and communicates effectively throughout the decision-making process. Pushes issues to resolution.
- Delivers Results: Is extremely results oriented. Is capable of deciphering priorities for self and for others, and focuses the group on what must be done today and who must do what. Focuses on results, not effort, and is able to efficiently direct time and energy to achieving intended outcome. Can successfully develop a budget and achieve it without sacrificing quality of output. Achieves strong results within functional area and understands organizational impact. Excellent track record of achieving or surpassing expected results. Understands how to operate in collaborative framework; results in a functional area should not come at expense of other team or function.
- Direct and Indirect Management: Makes decisions that benefit Bright over self. Is developing within the framework of the Bright Leadership Model, and can successfully influence direct and indirect teams to achieve goals. Organizes people and resources toward the effective and efficient pursuit of objectives: this includes hiring, firing, supervising and performance appraisals. Delivers thoughtful and constructive feedback to teams, and actively works to develop those around them. Knows how to make tough personnel decisions. Sets an example for employees. Is sought after by peers for 360 feedback. Manages up appropriately and knows how and when to escalate an issue or situation to more senior manager.
- Planning and Execution: Identifies need for planning and has skills to develop, implement, monitor and achieve plans. Knows how and when to adjust plan. Leads others in this effort. Hold self and team accountable for effective planning and execution. Overcomes hurdles.
- Presence: Excellent communication skills and represents Bright well. on various occasions, participates in external meetings (ex. With Care Partners, vendors, regulatory bodies, etc.). Internally, leads large and small groups of people in meetings. Capable of developing thoughtful agenda, setting objectives, driving clarity of purpose and delivering the intended results. Instills confidence in others.