Bright Health is delivering a smarter, more connected healthcare experience. Our affordable health insurance plans and exclusive partnerships with leading health systems are reshaping how people and physicians achieve better health. Today, Bright Health provides health insurance to individuals in Colorado, Arizona, and Alabama in both the Individual and Medicare Advantage space.
Come join our mission: Making Healthcare Right. Together!
SCOPE OF ROLE
Our Integrated Delivery Development 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.
- The Provider Relations Representative 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 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.