RBP Program Specialist

Responsibilities

• Supports the rollout and ongoing administration of the client's reference-based pricing (RBP) program; applies detailed understanding and in-depth working knowledge of the RBP plan design, pricing methodology, and vendor/TPA workflows; ensures the model is applied consistently and in accordance with plan documents.
• Serves as the embedded resource guiding employees to understand and navigate the RBP model; responds to member inquiries in a timely manner; educates employees on how reference-based pricing works, including provider selection and cost expectations; investigates and resolves member concerns, including balance billing situations; acts as a liaison between the client's HR department, employees, Lockton, and the RBP vendor/TPA.
• Completes various processes and program-related duties in collaboration with the client, including eligibility and enrollment processing, tracking and auditing of claims and repricing data, balance billing resolution support, reporting on program metrics and savings, and coordinating with vendors on escalations.
• Operates on a fluctuating schedule during open enrollment periods and/or special projects to meet the needs of the client, potentially including evenings or weekends.

Qualifications

Required Education and Experience

• High School Diploma/GED or professional direct experience equivalency.
• Minimum of three (3) years of subject matter expert experience working directly with a reference-based pricing (RBP) health plan model.
• Proven knowledge of medical billing, claims processing, and healthcare pricing/repricing concepts.
• Intermediate proficiency in Microsoft Excel.
• Demonstrated polished, articulate verbal and interpersonal communication skills with the ability to explain complex concepts to employees.
• Professional experience demonstrating superior customer service skills while multi-tasking and working under strict deadlines.
• Proven experience following a step-by-step process while using deductive reasoning to produce positive outcomes.

Preferred Education and Experience

• Five (5) or more years of professional experience implementing, administering, and/or supporting reference-based pricing programs.
• Experience with balance billing resolution, provider negotiation, and member advocacy.
• Working knowledge of self-funded health plans, TPA operations, and ERISA.
• Associate's or Bachelor's Degree or equivalent combination of education, training, or experience.