MISSION, VISION AND VALUES
“Making Healthcare Right. Together.” is the cornerstone of all we do. Our vision is to deliver the best healthcare experience by putting brilliant minds, empathetic hearts and personalized technology to work to create meaningful relationships between our members and Care Partners. To successfully achieve our mission and vision as we operate in a dynamic health care environment, we expect Bright People to embody and uphold our core values in work and interactions, both internal and external: Be Purposeful, Be Authentic, Be Brave, Be Positive and Be Respectful.
SCOPE OF ROLE
The Patient Financial Services Advocate is our members’ primary point of contact to help navigate and fight health care bills that they have received from hospitals and providers after the member has received out-of-network care. Bright Health’s model guides members to in-network local care partners to ensure affordable and high-quality healthcare. However, some members may receive care at out-of-network facilities in emergency situations. Bright Health covers members’ episode of care in these emergency situations. Unfortunately, in most states, hospitals and providers are free to bill emergency, out-of-network patients over and above what they have already received as reimbursement. Sometimes, hospitals and providers bill more than ten or twenty times (or more!) what they readily accept in reimbursement in other situations.
Bright Health aims to break this cycle by standing up to these billing practices. The Patient Financial Services Advocate will play an important Bright Health role in this initiative. The Patient Financial Services Advocate is a unique individual who possesses a unique blend of financially savviness and empathy – a social worker at heart who can stand toe-to-toe to power. We need someone who has a nuanced understanding of hospital billing practices and who will help our members to fight back against unreasonable financial demands. As our member’s primary point of contact, the Patient Financial Services Advocate will be the face of Bright Health working with our members at one of their most vulnerable and frightening moments. The Patient Financial Services Advocate will help members to understand the bills, what they owe, what’s reasonable (and what’s not), and then help the member to push back.
For more information on the problem that you will help to fight:
This description is intended to point out major responsibilities within the role, but it is not limited to these items.
1. Support members with high touch counsel including but not limited to:
o Listen, assess and understand the issues at hand
o Assist members in navigating complex billing practices
o Set clear expectations with members around complexity of the circumstances, time commitment to resolve and potential outcomes to expect
o Provide exceptional service to the member, including step-by-step resolution support
o Guide the member on how to effectively push back
2. Coordinate with Bright Health clinical professionals and vendors who are helping optimize patient care to help ensure the member continues to get the care they need
3. Lead negotiation and execution of resolution agreements with facilities and providers
4. Advocate for and protect members with effective “hold harmless” language
5. Coordinate legal support for member when negotiating with facilities and providers
o Provide the member with tools and messages to fight back
o Engage legal counsel when appropriate
6. As Bright Health grows, further develop, institutionalize, and standardize scalable processes
7. Track state and federal regulatory changes impacting hospital billing practices
8. Other duties and responsibilities as assigned
This position does not have supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
· A Bachelor’s degree in Health Care Administration, Communications, Social Work or a related field is preferred
· Four (4) or more years’ experience in the healthcare industry navigating relationships around providers and insurance networks is preferred.
· Four (4) or more years’ experience in a related field demonstrating empathy and understanding while championing the individual is required.
· Experience working in a highly regulated industry and familiarity with the legal process is required.
· Strong verbal and written communication skills
· Empathy for members experiencing fear after unexpected exposure to the healthcare system
· Ability to negotiate in trying circumstances
· Knowledge of and analytical skills to understand and apply regulatory guidance
· Detail oriented and structured thinker with proven ability to simultaneously manage multiple cases across different geographies
BEHAVIORAL AND LEADERSHIP NORMS
· Bright Values: Lives the Bright Values. Is focused on bravery needed to develop a variety skills. Not afraid to ask questions or take risks. Focuses on purposeful planning and objective setting. Focuses on the team’s successes, and how to support that effort.
· Collaboration: Is an effective collaborator that works well with the functional team and others in the organization to align on timelines and effective delivery of a project or task. Is solution oriented and works on generating input from multiple constituents and driving the team to a solution. Is able to work with different personality types and teammates to overcome differences in opinion and thought to achieve common company goals.
· Delivers Results: Is results oriented. Focuses on results and the best and most efficient avenue for achieving results. Works with manager or appropriate liaison in the organization to work through goal setting and milestone development to ensure timely and high-quality work product. Achieves strong results within functional area. Is focused on managing against a predetermined set of objectives and creates and follows process.
· Exhibits Curiosity: Focuses on learning about the business at large. Seeks to understand how they can drive the business forward and how the bigger picture works. Actively participates in his/her own career development.
· Multi-tasking: Balances multiple projects and initiatives at any given time. Alongside manager or appropriate Bright teammate, re-evaluates priorities based on changing company needs to understand what must be done today. Consistently meets deadlines.
· Upward Management: While balancing multiple initiatives, successfully manages expectations with appropriate project owner about capacity, challenges and barriers to success. Is not afraid to ask for help, guidance or feedback.
LICENSURES AND CERTIFICATIONS
· No licensures and/or certifications are required for this role.
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.