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Provider Relations Specialist-Bilingual

Company: Bright Health
Location: Miami
Posted on: February 24, 2021

Job Description:

Our Markets team is responsible for partnering with our Care Partners to turn their provider networks into market leading integrated delivery systems. We are reimagining how the network development, network management, and provider relations functions can advance affordable, simple, and personal care for our members. As our Provider Relations Representative, 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. YOUR RESPONSIBILITIES

  • Provider Account Management:
  • Ongoing, professional, and effective touchpoints 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
    • High School Diploma or GED required; Bachelor's degree in Business, Health Care Administration, Communications or a related field is preferred; equivalent work experience and education will be considered in lieu of a degree
    • Three (3) or more years of experience in the healthcare industry navigating relationships around providers and insurance networks is preferred PROFESSIONAL COMPETENCIES
      • 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
      • Proficiency with the Microsoft Office suite 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:--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.

Keywords: Bright Health, Miami , Provider Relations Specialist-Bilingual, Other , Miami, Florida

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