RBP Program Specialist

Lockton•Atlanta, GA

About The Position

This role supports the rollout and ongoing administration of a client's reference-based pricing (RBP) program. The specialist will act as an embedded resource for employees, guiding them to understand and navigate the RBP model. This includes responding to inquiries, educating employees on provider selection and cost expectations, and resolving member concerns, particularly balance billing situations. The role also involves operational duties such as eligibility and enrollment processing, tracking claims, reporting on program metrics, and coordinating with vendors. The schedule may fluctuate during open enrollment or special projects, potentially including evenings or weekends.

Requirements

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

Nice To Haves

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

Responsibilities

Supports the rollout and ongoing administration of the client's reference-based pricing 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.
Duties include 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.