Manager, Provider Network Informatics

Job Description - Manager, Provider Network Informatics (2400190)

Job Description

Manager, Provider Network Informatics-(2400190)

Description

This is a remote position. Eastern Time Zones preferred. Note, quarterly on-site requirement in Brooklyn, Ohio.

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.

2 million members 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.

Manages operations and staff performing analytics for health plan provider contract negotiations, including Institutional, Ancillary and Professional modeling, analysis, and reporting.

Oversees system administration for the provider reimbursement rate loading process, including quality control and testing.

Responsibilities

• Plans and manages the determination of appropriate rates for professional, ancillary and hospital contracts. Manages internal business relationships with Actuarial and Underwriting to determine how contracted rates will impact appropriate regions.
• Manages the analyses of payer value-based contract opportunities specific to capitated, bundled payments, and other emerging payment models to support the organizations drive toward alternative payment models.
• Plans and manages the rate loading process for provider contracts in assigned region. Manages internal business relationships with the Managers and / or Directors in the specified contracting regions.
• Ensures appropriate quality controls are in place through audits / tests to verify data integrity of rate loads and related information.
• Manages the preparation of monthly contract performance results and related financial reporting including interpretation and recommendations for improvement.
• Manages the completion of regular reports, as well as ad hoc reports to support Provider Contract Management, Underwriting and Actuarial, and other areas as necessary.
• Educates internal and external stakeholders about the terms and conditions of provider contracts and performance improvement opportunities.
• Performs other duties as assigned.

Qualifications

Qualifications

Education and Experience

• Bachelor’s degree in business or health care administration, public health, finance, accounting, or related field.
• Master’s degree preferred.
• 8 years progressive experience as a Provider Contract Analyst or equivalent experience in health care / managed care, 3 years of which are in a leadership role.

Technical Skills and Knowledge

• Comprehensive knowledge of and the ability to apply advanced concepts related to payer performance-based contracts, provider delivery systems, claims and clinical data.
• Superior financial analysis skills including forecasting and payment modeling.
• Intermediate to advanced Microsoft Office and database reporting skills.
• Knowledge of SAS programming.
• Excellent communication and presentation skills.
• Excellent organizational skills with managing projects and tight timeliness.

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.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community.

We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

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

Primary Location

US-Ohio

5 - Manager

Organization

Provider Network Informatics

Schedule

Regular

Shift

Standard

Employee Status

Manager

Job Type

Full-time

Job Level

Day Job

Job Posting

Apr 10, 2024, 8 : 15 : 31 PM