ABOUT THE ROLE
The Fee Configuration Specialist is a part of Health Plan Operations and helps to support all Fee Configuration activities.
- Build fee schedules based on contract rates and language
- Maintain quarterly fee schedule updates and maintenance based on Medicare
- Yearly full fee schedule updates based on Medicare’s first quarter update
- Work with TPA to ensure fee schedule builds will auto adjudicate and remediate claim pends associated to fee schedule data
- Give contracting team strategic advice to ensure contract language and rate sheets will result in high auto adjudication
- Audit claims adjudication for compliance with contract rates and terms
- Assist cross functionally when needed
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Minimum high school diploma or GED is required; Associates or Bachelor’s degree preferred
- Five (5) or more years of experience in a like role is preferred; experience with facility contract configuration preferred
- Must have strong communication skills (verbal and written)
- Must be organized, detail-oriented, and be able to prioritize work to meet deadlines
- Must work independently with little supervision
- Experience in commercial and Medicare fee schedule buildout required
- Experience with Genelco and/or facility contracts preferred
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.
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