Provider Reimbursement Analyst

This position has the option to work hybrid or remote; Eastern Time Zones preferred.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.

6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Responsibilities

Provider Reimbursement Analyst II

Under general supervision, supports assigned provider network contracting region with typically routine to moderately complex financial analysis.

Maintains market intelligence and analyzes network performance to provide Provider Engagement with consultative and analytical insights.

• Analyzes contracted rates to assist with determining appropriate rates for provider contracts.
• Updates and provides quality assurance of provider rate loading.
• Prepares monthly contract performance results and related financial reporting including interpretation and recommendations for improvement.
• Works on various projects related to the analysis of claims, clinical and financial data, with a focus on improvement of financial and / or clinical outcomes.
• Gathers data from multiple sources and develops necessary analytic data result sets to enable accurate and robust quantitative analyses.
• Analyzes payer value-based contract opportunities, including pay for performance, population health, gain or risk sharing, bundled payments, and other emerging payment models to support the organizations drive toward alternative payment models.
• Performs other duties as assigned.

Provider Reimbursement Analyst III

Under general to limited supervision, supports assigned provider network contracting region with typically moderately complex financial analysis.

Maintains market intelligence and analyzes network performance to provide Provider Engagement with consultative and analytical insights.

• Analyzes contracted rates to assist with determining appropriate rates for provider contracts. Coordinates with Actuaries and Underwriting to determine how contracted rates will impact appropriate regions.
• Prepares monthly contract performance results and related financial reporting including interpretation and recommendations for improvement.
• Prepares short- and long-range financial forecasting and related financial planning processes related to contract revenues and performance.
• Works on various projects related to the analysis of claims, clinical and financial data, with a focus on improvement of financial and / or clinical outcomes.
• Updates and provides quality assurance of provider rate loading.
• Analyzes payer value-based contract opportunities, including pay for performance, population health, gain or risk sharing, bundled payments, and other emerging payment models to support the organizations drive toward alternative payment models.
• Analyzes and creates provider incentive distribution programs, including the periodic reporting of results, annual distribution calculations and budgeting.

Supports the development of innovative distribution models to increase physician and practice engagement in quality improvement initiatives and outcomes.

• Collaborates within the organization to perform ad hoc analysis as assigned.
• Performs other duties as assigned.

Senior Provider Reimbursement Analyst

Under limited supervision, supports assigned provider network contracting region with typically more complex financial analysis.

Maintains market intelligence and analyzes network performance to provide Provider Engagement with consultative and analytical insights.

Mentors other analysts.

• Analyzes contracted rates to assist with determining appropriate rates for provider contracts. Coordinates with Actuaries and Underwriting to determine how contracted rates will impact appropriate regions.
• Works on various projects related to the analysis of claims, clinical and financial data, with a focus on improvement of financial and / or clinical outcomes.
• Updates and provides quality assurance of provider rate loading.
• Orients, trains, and assists more junior level Analysts, including sign off on recommendations for non-complicated professional negotiations.
• Collaborates within the organization to perform ad hoc analysis as assigned.
• Analyzes payer value-based contract opportunities, including pay for performance, population health, gain or risk sharing, bundled payments, and other emerging payment models to support the organizations drive toward alternative payment models.
• Analyzes and creates provider incentive distribution programs, including the periodic reporting of results, annual distribution calculations and budgeting.

Supports the development of innovative distribution models to increase physician and practice engagement in quality improvement initiatives and outcomes.

• Prepares monthly contract performance results and related financial reporting including interpretation and recommendations for improvement.
• Prepares short- and long-range financial forecasting and related financial planning processes related to contract revenues and performance.
• Performs other duties as assigned.

Lead Provider Reimbursement Analyst

Under minimal supervision, acts as thought leader in Provider Contracting. Conceptualizes new approaches to reimbursements and measuring provider performance.

Develops new win-win scenarios for the Company and provider. Assists in the support of each contracting region of the Company's provider network with financial analysis.

Maintains market intelligence and analyzes network performance to provide Provider Engagement with consultative and analytical insights.

Strategically & proactively facilitating change to gain greater efficiencies Mentors other analysts.

• Analyzes contracted rates to assist with determining appropriate rates for provider contracts. Coordinates with Actuaries and Underwriting to determine how contracted rates will impact appropriate regions.
• Works on various projects related to the analysis of claims, clinical and financial data, with a focus on improvement of financial and / or clinical outcomes.
• Collaborates within the organization to perform ad hoc analysis as assigned.
• Prepares monthly contract performance results and related financial reporting including interpretation and recommendations for improvement.
• Prepares short- and long-range financial forecasting and related financial planning processes related to contract revenues and performance.
• Orients, trains, and assists more junior level Analysts. May participate in interviewing and recommendations for hire, performance management and training and development of staff.

Approve recommendations on increasingly complex professional and ancillary negotiations.

• Analyzes payer value-based contract opportunities, including pay for performance, population health, gain or risk sharing, bundled payments, and other emerging payment models to support the organizations drive toward alternative payment models.
• Analyzes and creates provider incentive distribution programs, including the periodic reporting of results, annual distribution calculations and budgeting.

Supports the development of innovative distribution models to increase physician and practice engagement in quality improvement initiatives and outcomes.

• Provide quality assurance of provider rate loading.
• Performs other duties as assigned.

Qualifications

Qualifications

Provider Reimbursement Analyst II

• Bachelor's degree in business or healthcare administration, finance, accounting, or related field.
• 2 years of experience as a Provider Reimbursement Analyst or equivalent health care administration experience, preferably in managed care.
• Provider Contracting / Network Management experience a plus.
• Intermediate Microsoft Office Excel, Word, Access, and PowerPoint skills.
• Working knowledge of SAS and / or SQL; knowledge of writing queries and analytical reports preferred.
• Experience working with relational databases.
• Knowledge of provider contracting.

Provider Reimbursement Analyst III

• Bachelor's degree in business or healthcare administration, finance, accounting, or related field.
• 3-4 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting / Network Management.
• Intermediate Microsoft Office Excel, Word, Access, and PowerPoint
• Working knowledge of SAS and / or SQL; knowledge of writing queries and analytical reports preferred.
• Ability to quickly learn and use software business intelligence tools.
• Experience working with relational databases.

Senior Provider Reimbursement Analyst

• Bachelor's degree in business or healthcare administration, finance, accounting, or related field.
• 5 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting / Network Management.
• Advanced financial analysis skills including forecasting and payment modeling.
• Advanced computer skills including Excel, Word, Access, and PowerPoint.
• Ability to utilize SAS programming language in assigned analysis.
• Ability to quickly learn and use software BI tools.
• Experience working with relational databases.
• Ability to apply technical skills and operational knowledge to produce actionable results and analysis.

Lead Provider Reimbursement Analyst

• Bachelor's degree in business or healthcare administration, finance, accounting, or related field. MBA Preferred.
• 7 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting / Network Management.
• Advanced financial analysis skills including forecasting and payment modeling.
• Advanced computer skills including Excel, Word, Access, and PowerPoint.
• Ability to utilize SAS programming language in assigned analyses.
• Ability to mentor junior analysts.
• Experience working with relational databases.
• Ability to apply technical skills and operational knowledge to produce actionable results and analysis.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees.

That's why we offer an exceptional package that includes :

A Great Place to Work :

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available.

Enjoy the use of weights, cardio machines, locker rooms, classes and more.

• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation :

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work / life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You :

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual :

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors.

Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans.

We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.