Provider Reimbursement Analyst

Company: Medical Mutual of Ohio
Location: Cleveland
Posted on: June 13, 2021

Job Description:

Provides analytical support during contract negotiation process. Assists contracting in building tools that model rate. Provides understanding of financial impact based on history. Performs claims repricing, discount analyses, etc. to support group sales efforts and RFPs. Measures accuracy of projections. In the forefront of managing and tracking medical costs for senior leadership team by implementing strategic and tactical solutions.

Responsibilities

• Provides tactical support and recommendations to contracting by assisting with analyses, projects, etc. Supports negotiation and contract interpretation and compliance.

• Plans, monitors and evaluates current network performance to determine effectiveness and develop and implement system enhancements by defining business requirements to ensure MMO's competitive advantage. Often requires coordination among multiple business areas.

• Maintains project-level responsibility for projects and deliverables through collaboration with other analyst(s) and support staff. Provides peer review, training and limited oversight.

• Synthesizes information and imparts personal knowledge related to cost and quality transparency efforts for multiple audiences including, providers and consumers.

Qualifications

• Bachelor's degree in business administration, economics, statistics, IT or related field
• 2 - 6 years' experience in health care consulting, provider contracting, or provider reimbursement experience.
• Demonstrated experience and knowledge of systems applications and implementations, including spreadsheet and database applications.
• Strong mathematical aptitude with a demonstrated ability to make quantitative and analytical assessments, forecasts and projections.
• Demonstrated leadership skills and/or project management experience.
• Knowledge of CMS pricing methodologies preferred.

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:

• Top Workplace in Northeast Ohio. Year after year we've received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 80 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual 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.

Keywords: Medical Mutual of Ohio, Cleveland , Provider Reimbursement Analyst, Other , Cleveland, Ohio