“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is through powerful relationships with Care Partners, we help all people live healthy and brighter lives. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright employees to embody and uphold our core values in work and interactions, both internal and external: be brave, be brilliant, be accountable, be inclusive, and be collaborative.

The Reimbursement Policy Program Manager is responsible for identifying, drafting, prioritizing, and support implementing Bright Health Plan reimbursement policies in support our Commercial (Individual and Family Plan and Employer) and Medicare Advantage lines of business. You are expected to evaluate and develop reimbursement payment policies to effectively manage and control medical claims costs. You are responsible for supporting leading cross-functional departments 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.

This role is accountable for supporting the company’s performance by supporting the development of our reimbursement policy strategy that also supports the advancement of Bright’s relationship with our Care Partners, network partners, aligned providers and members.

ROLE RESPONSIBILITIES

• Develop, draft, implement, annual revise, and overall build out of reimbursement payment policies repository
• Assist with setting 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

• A Bachelor’s degree or equivalent work experience is required
• Five (5) or more years of complex managed care concepts and processes is required
• Five (5) or more years of coding, billing, and claims processing is required
• Technical policy writing and editing experience is required
• In-depth knowledge and application of federal, state and CMS based requirements, regulations, and policies is required
• Three (3) to five (5) years of health insurance pricing and associated benefit design knowledge is preferred
• Experience of at least three (3) or more years in Premium Billing, Claims, Member and Provider Service, and Appeals at a health insurance company is preferred
• Advanced proficiency with Microsoft Excel and Microsoft Power Point is required
• Advanced knowledge of MS Project, MS Visio and/or Lucid Charts preferred

PROFESSIONAL COMPETENCIES

• Previous health care experience, preferably in one of more of the following areas: claims, provider systems or health plans
• Strong collaboration skills to work with internal and external teams to effectively design solutions that meet the business needs
• In-depth knowledge of federal, state and CMS based requirements and the ability to develop, distribute and administer Medicare program requirements in a compliant manner
• 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
• Strong problem-solving skills
• Able to manage resources in a matrix environment, communicating and influencing effectively at all levels of the organization
• Effective at vendor negotiations and relationship management.
• Broad knowledge of health insurance and services delivery and functions
• Success managing multiple initiatives and priorities simultaneously.
• Able to quantify impact and ROI of initiatives.
• Experience in government programs including Exchanges, Medicare and/or Medicaid.
• Experience with integrating health plan support services and other elements of operations in high-growth environment.
• High attention to detail
• Strong analytical skills, work ethic, problem solving ability, and overall positive attitude
• Demonstrated flexibility, organization, and self-motivation 

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 Modern Healthcare and Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our 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!