Manager, Provider Compliance

Job description

About the Role Brighton Health Plan Solutions is seeking an experienced Manager of Provider Compliance to lead and oversee the investigation and resolution of provider disputes related to the No Surprises Act. The Manager of Provider Compliance is responsible for directing and reviewing all determination responses to ensure full compliance with established No Surprises Act guidelines and regulatory requirements. This role provides leadership and subject matter expertise to the Provider Compliance team, ensuring consistent, accurate and timely outcomes. The ideal candidate will be skilled in healthcare claims processing, including both professional and facility claims, and well as deep experience in healthcare provider contract negotiation. This is a remote position. Primary Responsibilities: - Oversee all aspects of the No Surprises Act to ensure ongoing regulatory compliance. - Provide strategic oversight and thorough review of QPA claims, negotiations and agreements, and Independent Dispute Resolution (IDR) determinations. - Conduct and guide advanced claim research including professional, facility and ancillary claims. - Lead provider contract research, including rate analysis a...