ABOUT THIS ROLE
Our Markets Team is responsible for developing and managing the long-term strategy, relationships, and contracts with our Care Partners and top network providers, as well as assisting in making our insurance product offerings in local markets successful. The Markets Team is comprised of Bright Health’s Market Leadership and Provider Relations functions, which collectively serve to support the implementation of our health plans in each market, track and drive performance of these plans, and foster strategic alignment between Bright Health, our Care Partners, and our local network of providers.
As our Provider Relations Specialist, you will manage the flow of all current and future provider communications, service, issue resolution, and data management to and from our Care Partner and other providers in the market to build the foundation for a strong connection between Bright and our provider partners.
- The Provider Relations Specialist description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Provider Account Management
- Ongoing, professional, and effective touch points with all active providers in Bright’s network
- Relationship manager for Care Partner provider relations’ staff
- Provide high level of customer service
- Build provider awareness of and engagement with Bright Health
- Provider Education and Network Management
- Proactive research and resolution of provider issues including but not limited to claims submission, processing, and payment; contracting details; provider tools; and UM and other protocols
- Ensure accurate ongoing collection of key provider data element updates and changes
- Supporting providers through the credentialing/re-credentialing process, including addressing provider questions, ensuring timely completion of applications, and supporting the Bright Health credentialing team
- Hold education sessions for providers to ensure alignment and understanding of Bright Health
- Collaborate with Care Partner Provider Relations staff in the creation and distribution of orientation and educational materials to all levels of personnel within a hospital, ancillary services or physician office setting
- Provider Development and Contracting
- Proactive identification and closure of network gaps as well as development of performance reports
- Lead negotiation and execution of additions and renewals of provider contracts to ensure network adequacy
- Own maintenance of contract management system for assigned provider contracts
- Cross-functional Bright support
- Serve as internal Bright Health provider advocate by communicating key provider pain points and working with key stakeholders to advance our support of our contracted providers
- Collaborate with Marketing, Sales, Provider Data, Credentialing, Operations, HOT, and other teams to coordinate cross-functional in-market activities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree in Business, Health Care Administration, Communications or a related field is required.
- Five or more years of experience in the healthcare industry navigating relationships around providers and insurance networks is preferred
- Strong verbal and written communication skills
- Possess strong business acumen and professionalism
- Demonstrated ability to serve in a customer (provider) facing role and collaborative and relationship-driven style in building effective data transmissions between entities
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.
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.
Bright Health is tripling its footprint in 2019 to offer a variety of health insurance plans to more individuals. Bright Health operates health insurance offerings across Individual and Family Plan segments and the Medicare Advantage space in Alabama, Arizona, Colorado, Ohio, New York and Tennessee.
We’re Making Healthcare Right. Together.
We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing 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.