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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 Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
- 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
- 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
- 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
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.