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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.


 

SCOPE OF ROLE

Reimbursement Policy Programs Manger is a critical part of the Bright HealthCare Finance team and is responsible for supporting the day-to-day process and functions of Bright’s Reimbursement Policy Programs implementation, auditing, and optimization. The position will partner with multiple cross-functional teams and will be accountable to ensure the success of the Out of Network Payment Policy program and other related reimbursement policy programs. The Reimbursement Policy Programs Manger role will own pipeline and management of reimbursement policy programs. This position will support business case development, OON medical cost management process, identification of medical cost containment opportunities, successful management, oversight, and execution of high priority reimbursement program initiatives and tracking of program outcomes. The position will assist with defining and executing both department and corporate strategy.

The successful candidate will be a self-starter and will have a proven track record of succeeding in fast-paced and complex health plan settings. You have a demonstrated ability to connect data analysis across multiple functional areas to actionable and measurable initiatives. You excel at seeing both the “big picture” and also the detail necessary to ensure initiatives are being managed with high quality. You lead with accountability; are an excellent verbal and written communicator; operate with strong attention to detail. Your colleagues and clients recognize you for leading through influence, having empathy towards others, being highly collaborative and strongly exhibit the ability to drive towards measurable outcomes.

ROLE RESPONSIBILITIES

Reimbursement Policy Programs Manager job description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Manage and support the implementation of Bright Health’s OON Payment policy program and other prioritized reimbursement policy programs from start-to-finish, including but not limited to implementation, execution, post implementation process oversight, and insourcing.
  • Own reimbursement policy program process improvement, audits program fees and payment methodology accuracy. 
  • Identify medical cost saving opportunities and trends through reimbursement policy program oversight, auditing, and efficacy evaluations
  • Manage and report on reimbursement policy programs performance.
  • Partner with stakeholders across the organization including but not limited to clinical, networks, markets, provider relations and medical management to drive strategic priorities and initiatives.
  • Monitor utilization/trends for non-participating providers and execute on organizational strategies to enhance provider networks.
  • Prioritize reimbursement policy priorities based on financial impact, ease of administration/implementation, regulatory requirements, etc.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Five (5) or more years of experience in a health care/ payer-provider contracts or partnerships or related field required with at least with at least three years’ experience of (3) operations methodology, error detection/resolution techniques, quality assurance techniques, and experience in analytics, network management, or reimbursement model design. 
  • Experience in estimating, planning, and executing large scale, time sensitive initiatives in a matrixed environment
  • Advanced proficiency with Microsoft Excel and Microsoft Power Point required
  • Data governance, data integration and database experience is required
  • Three (3) or more years’ experience with policy, program, and/ or system audits
  • Governance, Risk and Compliance software experience, preferred

PROFESSIONAL COMPETENCIES

  • Previous health plan experience, preferably in one of more of the following areas: payment policies, finance, medical cost management
  • Strong collaboration skills to work with internal teams to effectively identify and manage implementation of new solutions that achieve the targeted medical cost goals
  • Excellent written and verbal communication skills
  • Ability to perform multiple tasks and prioritize simultaneously
  • Ability to perform critical analysis of complex problems and propose appropriate solutions
  • Advanced time management and project management
  • High attention to detail
  • Demonstrated flexibility, organization, and self-motivation
  • Adaptable to change

WORK ENVIRONMENT

  • The majority of work responsibilities are performed remotely carrying out detailed work sitting at a desk/table and working on the computer.
  • Travel may be required.
 

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          

 
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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