Job Description - Provider Reimbursement Analyst (2400258)
Provider Reimbursement Analyst - (2400258)
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.
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.
- 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.
- Analyzes contracted rates to assist with determining appropriate rates for provider contracts and coordinates with Actuaries and Underwriting.
- 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.
- Works on various projects related to the analysis of claims, clinical and financial data.
- Updates and provides quality assurance of provider rate loading.
- Analyzes payer value-based contract opportunities.
- Analyzes and creates provider incentive distribution programs.
- 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. Mentors other analysts.
- Analyzes contracted rates to assist with determining appropriate rates for provider contracts.
- Works on various projects related to the analysis of claims, clinical and financial data.
- Updates and provides quality assurance of provider rate loading.
- Orients, trains, and assists more junior level Analysts.
- Collaborates within the organization to perform ad hoc analysis as assigned.
- Analyzes payer value-based contract opportunities.
- Analyzes and creates provider incentive distribution programs.
- Prepares monthly contract performance results and related financial reporting.
- Prepares short- and long-range financial forecasting and related financial planning processes.
- 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.
- Analyzes contracted rates to assist with determining appropriate rates for provider contracts.
- Works on various projects related to the analysis of claims, clinical and financial data.
- Collaborates within the organization to perform ad hoc analysis as assigned.
- Prepares monthly contract performance results and related financial reporting.
- Prepares short- and long-range financial forecasting and related financial planning processes.
- Orients, trains, and assists more junior level Analysts.
- Analyzes payer value-based contract opportunities.
- Analyzes and creates provider incentive distribution programs.
- Provides quality assurance of provider rate loading.
- Performs other duties as assigned.
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.
- Intermediate Microsoft Office skills.
- Working knowledge of SAS and/or SQL.
- 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.
- Intermediate Microsoft Office skills.
- Working knowledge of SAS and/or SQL.
- 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.
- Advanced financial analysis skills.
- Advanced computer skills.
- Experience working with relational databases.
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.
- Advanced financial analysis skills.
- Advanced computer skills.
- Experience working with relational databases.
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.
- Access to on-site fitness centers or gym membership reimbursement.
- On-site cafeteria at the Brooklyn, OH headquarters.
- Discounts at many places in and around town.
- Opportunity to earn cash rewards for shopping with our customers.
Excellent Benefits and Compensation:
- Employee bonus program.
- 401(k) with company match up to 4% and additional contribution.
- Health Savings Account with matching contribution.
- Excellent medical, dental, vision, life, and disability insurance.
- Access to an Employee Assistance Program.
- Company holidays and up to 16 PTO days during the first year.
- Parental leave for eligible employees.
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.
- Diverse, inclusive, and welcoming culture.
About Medical Mutual:
Medical Mutual is a mutual company, focusing on products and services that serve our customers and communities.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
#J-18808-Ljbffr
