Bright Health
Through powerful relationships with care partners, Bright Health aims to help people live healthier and brighter lives
Austin, TX
Remote

Reimbursement Policy Program Manager at Bright Health

| Remote
Sorry, this job was removed at 6:27 a.m. (CST) on Wednesday, July 28, 2021
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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!

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Where we are

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.

Technology we use

  • Engineering
  • Product
  • Sales & Marketing
    • .NETLanguages
    • C#Languages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • ScalaLanguages
    • SqlLanguages
    • PowerShellLanguages
    • D3JSLibraries
    • ReactLibraries
    • ReduxLibraries
    • FlutterLibraries
    • ExpressFrameworks
    • Node.jsFrameworks
    • MongoDBDatabases
    • MySQLDatabases
    • PostgreSQLDatabases
    • InVisionDesign
    • SketchDesign
    • Lucid ChartDesign
    • Aha!Management
    • ConfluenceManagement
    • JIRAManagement
    • Microsoft ProjectManagement
    • Microsoft DynamicsCRM

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 a Lifestyle Spending Account and options for HSA/FSA. We put 3% of your total earnings into your 401K plan and you are immediately vested. 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 sync
Open door policy
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Pair programming
Open office floor plan
Diversity
Dedicated Diversity/Inclusion Staff
Unconscious bias training
Someone's primary function is managing the company’s diversity and inclusion initiatives
Mean gender pay gap below 10%
Hiring Practices that Promote Diversity
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
Wellness Programs
Bright Health is proud to offer a wellness stipend of $200/month to all employees!
Onsite Gym
Mental Health Benefits
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
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.
Remote Work Program
Family Medical Leave
Company sponsored family events
Bright Health sponsors family oriented events Annually.
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Commuter Benefits
Stocked Kitchen
Happy Hours
Happy hours are hosted on occasion.
Relocation Assistance
Fitness Subsidies
Bright Health employees are eligible for discounts on several gym memberships.
Home Office Stipend for Remote Employees
Professional Development Benefits
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Online course subscriptions available
Customized development tracks

Additional Perks + Benefits

Bright's primary goal is to offer employee benefits and perks that are as flexible as possible to meet each employee's unique needs!

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?

My day is so varied, given how quickly we're growing, which is fulfilling for me. I have a good balance of strategic and tactical work in my day as well as time to focus and time to collaborate.

Jen

VP, Digital

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

Software Engineer 3

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

Bright Health Careers In Austin
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Remote
1 week ago
JOB DUTIES AND RESPONSIBILITIES The Compliance Analyst job description is intended to point out major responsibilities within the role, but it is not limited to these items. Create, maintain and publish plan and benefit materials based on regulatory requirements and product lifecycle deadlines. Technical writing of, and revisions to, policy forms to ensure compliance with regulatory standards and developments. Track regulatory filings through SERFF, CMS Enterprise Portal, and other applicable filing systems.

Senior Analyst – Regulatory Affairs

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, Market Development

Bright Health
Remote
1 week ago
Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

Director, Market Development

Bright Health
Remote
1 week ago
Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

Software Engineer 3 - Enablement

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Program Manager – New Market Entry (Compliance)

Bright Health
Austin
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. Product Manager

Bright Health
Remote
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior IT Project Manager- Marketing Technologies

Bright Health
Austin
1 week ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. Software Engineer, Data Enablement

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Product Manager, Bright Enablement

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, National Market Operations

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, Utilization Management

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, IFP Customer Success – Multicultural Strategy Execution

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Manager, Case Management

Bright Health
Remote
2 weeks ago
Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

Desktop Support Specialist - CRM Admin

Bright Health
Austin
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Software Engineer 1

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Business Analyst - Risk Adjustment

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Telephony Engineer

Bright Health
Austin
2 weeks ago
RESPONSIBILITIES Customer support, training, and communication Configuration, integration, and troubleshooting end user applications Administration of end user application Maintenance of end user applications

Director, Operations

Bright Health
Remote
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. User Experience Designer

Bright Health
Austin
2 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior IT Project Manager - Infrastructure

Bright Health
Austin
2 weeks ago
ROLE RESPONSIBILITIES Manage different types of projects including those around enterprise Digital Asset Management, CRM platforms, Digital Experience application development, solution orchestration and integration, product selection and implementation, upgrades and deployments and operational efficiency improvements Be able to pull together numerous aspects of a proposed solution, to create a cohesive and organized plan, motivate resources to execute on that plan, and drive the plan through to its final and committed completion Bring clarity to project objectives, plan and deliverables such that conflicts are minimized

Data Analyst

Bright Health
Remote
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Director, Security Engineering

Bright Health
Austin
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Sr. Provider Analytics Consultant - Smart Networks

Bright Health
Remote
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Senior Technical Project Manager

Bright Health
Austin
3 weeks ago
Back to Career Site Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes. What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be

Manager - Smart Networks

Bright Health
Remote
3 weeks ago
The Manager, Network Strategy job description is intended to point out major responsibilities within the role, but it is not limited to the following: Manage Network Strategy team members and support strategy and network development efforts. Drive advancement of network design strategy, overseeing development of proprietary Bright standards, alignment to regulatory requirements, and evaluation of development needs across both active and new markets. Set performance standards for Network and Market teams regarding network construction for active and new markets, partnering cross-functionally to advance Bright’s performance and footprint.

Manager - Smart Networks

Bright Health
Remote
3 weeks ago
The Manager, Network Strategy job description is intended to point out major responsibilities within the role, but it is not limited to the following: Manage Network Strategy team members and support strategy and network development efforts. Drive advancement of network design strategy, overseeing development of proprietary Bright standards, alignment to regulatory requirements, and evaluation of development needs across both active and new markets. Set performance standards for Network and Market teams regarding network construction for active and new markets, partnering cross-functionally to advance Bright’s performance and footprint.