Bright HealthCare
SCOPE OF ROLE
Our Markets team is responsible for partnering with our Care Partners (CPs) to turn their provider networks into market-leading integrated delivery systems. As a Provider Relations team member, you will manage provider communications, service, issue resolution intake, case submission, case closure, as well as 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. Provider Relations team members are also expected to onboard new practices and CPs, including providing orientations, in-person visits, and education on how to work with Bright.
ROLE RESPONSIBILITIES
The Senior Provider Relations Specialist 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 a high level of customer service
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
- Build provider awareness of and engagement with Bright Health
Cross-functional Bright support
- Serve as an 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 instead 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
WORK ENVIRONMENT
- 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.