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.
The Provider and Network Relations Representative is responsible for initiating and maintaining relationships with Direct and Delegated Care Partners, MSO and external vendors. This position is responsible for assuring accurate provider data is received and processed so Bright Health can effectively provide monitoring, training, education and resources to Care Partners. The Provider Relations Representative acts as the company liaison communicating Bright Health ’s policies and procedures, assisting the Care Partner with medical cost management, data reporting, Quality performance, membership growth, contracting, credentialing and program implementation concerns. The position requires the Representative to efficiently and effectively assess the needs of the Care Partner and to meet those needs in a timely and comprehensive manner. Representatives must possess excellent communication and problem solving skills along with an extensive knowledge of managed care practices. The Provider Relations Representative will be responsible and accountable for multiple product lines including Medicare Advantage, Medi-Cal and Commercial lines of business.
It is expected that the employee demonstrate behavior consistent with the core values of Bright Health. The employee will also be expected to support all organizational initiatives and departments including, but not limited to: Customer Service, Patient’s Rights, HIPPA compliance, Bright Health standards of Conduct.
Provider Relations Representatives essential duties and responsibilities
- Conducts training and education to Care Partners on company operational and utilization Management practices
- Working knowledge of medical cost management and assist Care Partners in implementing performance strategies
- Support strategic membership growth based on company benchmarks in assigned market areas
- Conducts Onboarding for new Care Partners on all Bright Health care programs and operations
- Conducts in person or remote training with Care Partners, including but not limited to plan benefits, plan specific patient management program data management systems, website and SFTP navigation.
- Oversees Joint operations and regularly scheduled operational meetings with Care Partners to educate them on risk, medical management and quality measures.
- Educates Care Partners on HEDIS and STAR policies, programs and initiatives related to Bright Health goals
- Responsible for the completion of market specific strategies pertaining risk adjustment accuracy in coordination with health plan resources.
- Establishes ongoing and effective communication with Care partners.
- Responsible for timely and professional interaction with Care Partners including escalating recurring or critical issues to appropriate Market Leader
- Extensive coordination and accountability across internal health plan teams, MSO, external vendors and Care Partners
- Assesses the changing needs of assigned market, identifies network gaps in collaboration with network development protocols.
- Participates in special projects as assigned or directed.
Qualifications/ Education/Training Experience
- Possesses a working knowledge of Managed care plans and programs
- Bachelor’s Degree or equivalent experience preferred
- Minimum 2 year’s of managed care experience specific to Medicare Advantage or other relevant experience
- Superior organizational skills and the ability to handle multiple tasks simultaneously
- Ability to work independently
- Excellent interpersonal and communication skills (both written and oral)
- Excellent Microsoft office program knowledge
- Knowledge of medical terminology
- Knowledge of HEDIS, STAR, Risk adjustment practices
- Ability to perform job duties in a remote setting including teleconferences
- Ability to change priorities regularly
- Must possess and maintain valid driver's license
- Must have access to reliable, insured vehicle and be able to travel regularly throughout the assigned territory
We’re Making Healthcare Right. Together.
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.