SCOPE OF ROLE

The Network Development team is responsible for partnering with our care providers to turn our 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.

The Senior Provider Contract Specialist will be a key contributor to our Network Development team and a thought leader for provider networks. This position will play an integral role in driving the company’s performance by building, optimizing, and transforming our provider networks. This position will be responsible for developing and maintaining provider relationships and negotiating participation agreements with key local care providers as well as for advancing reimbursement best practices.

ROLE RESPONSIBILITIES

• The Senior Provider Contract Specialist description is intended to point out major responsibilities within the role, but it is not limited to these items.
• Lead the provider contracting efforts from start-to-finish, including but not limited to process oversight, strategic diligence, outreach, and contract negotiations with large and small physician groups and ancillary providers and mid-sized and large hospitals and health systems
• Effectively negotiate rates, structures, and contract language with a range of provider types across multiple geographies
• Support collaboration with our care providers to analyze, design, and develop networks through ongoing evaluation of both current and potential network participants
• Support and enhance Bright Health’s portfolio of strategic national and multi-regional network partnerships to compliment local network development efforts
• Manage ongoing network participation and performance, including performance analytics and management, as well as contract renewals and terminations
• Partner with stakeholders across the organization including, but not limited to sales, finance, regulatory and medical management to drive strategic priorities and initiatives
• Monitor utilization trends for non-participating providers and execute on organizational strategies to ensure members are seeking care with participating providers when appropriate

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• At least four (4) years of experience within the healthcare industry with at least two (2) years of experience in network development, network management or reimbursement model design required
• Bachelor’s degree in business, economics, healthcare administration or a related field is preferred.  Additional equivalent experience is preferred in lieu of a Bachelor’s degree.
• Experience with successful execution and implementation of payer-provider contracts or partnerships required.
• Experience with developing, presenting and analyzing various types of financial analyses in order to make informed strategic decisions preferred.
• Experience working with dental, vision and other provider networks for supplemental / ancillary benefits preferred
• Experience commercializing digital health and clinical products to consumers, patients, members, and/or providers preferred
• Proficiency in Windows-based computer applications-Microsoft Word, Microsoft Excel and Microsoft Power Point-is required

PROFESSIONAL COMPETENCIES

• Strong attention to detail and analytical skills; ability to organize and analyze data
• Superb written and verbal communication skills with an ability to effectively collaborate with internal and external executive leadership
• Ability to collaborate cross-functionally across departments and various level roles in the organization
• Able to manage time effectively, understand directions, and work independently in a fast-paced environment
• Willingness to learn and operate in ambiguity
• Desire and ability to move quickly between strategic leadership, tactical execution, and managing analytics
• Knowledge of managed care practices and procedures, specifically in contracting language and negotiations
• Ability to effectively engage providers, ranging from national providers to regional integrated delivery systems to local physician practices
• Able to make decisions regarding own work methods, requires minimal direction and receives guidance where needed. Follows established guidelines/procedures
• Excellent multitasking and prioritization skills with a proven ability to manage multiple projects in parallel to completion

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting or remotely, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.