Director, Health Plan Operations
Minneapolis, MN /
Operations – Health Plan Operations /
Our 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 the Director, Health Plan Operations, you will be responsible for organizing and advancing Bright Health’s provider data infrastructure as it relates to roster management, data quality and accuracy, fee schedule builds, and integration with other Bright and third-party databases. You will be accountable for driving the company’s performance and strategy by ensuring timely, efficient, and accurate provider data and fee schedule flows throughout Bright Health.
- Oversee core provider data infrastructure, including system development, maintenance and updates, and accuracy oversight
- Develops upfront provider roster data implementation and ongoing maintenance, including regular updates of all provider demographic and billing information
- Partners with Care Partner network operations and credentialing teams to build out data integrations and improve Care Partner data accuracy
- Maintains provider data accuracy through management of provider data monitoring and audit program
- Collaborates with operations team to build claims issue resolution infrastructure related to provider data accuracy and infrastructure
- Builds and analyzes ad hoc analysis as required by DOI/CMS provider data filings, individual provider complaints, and as otherwise required
- Supports network adequacy review and gap closure process by ensuring timely and accurate updates are made to internal provider data
- Builds reporting capabilities to manage all regular and ad hoc provider data reporting requirements
- Maintains and manages all provider finder regulatory requirements across all states and products
- Supervises fee schedule configuration as part of contract implementation and maintenance updates
- Builds collaborative relationships with other Bright leaders to achieve corporate, financial and market objectives
- Participates in cross-departmental teams to analyze business opportunities and address critical issues (e.g. network growth, provider terminations, etc.)
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree strongly preferred or equivalent work experience
- Eight (8) or more years’ experience in the healthcare field; Five (5) years of progressive experience working in managed care operations, such as provider contracting, claims payment, provider data management and/or system configuration
- Five (5) or more years’ direct supervisory experience required
- Ability to work independently as well as collaborate in groups
- Strong skills in listening, verbal, and written communications
- Ability to think innovatively and creatively solve problems; strong analytical skills
- Excellent customer service skills with internal and external stakeholders
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.