Provider Analyst
: Job Details :

This is a remote opportunity. Note, quarterly/ad-hoc/situational on-site requirement in Brooklyn, Ohio. Eastern & Central 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 Analyst II Provides analytical support during contract negotiation process. Assists contracting in building tools that model rate. Organizes and performs analytical review of opportunities with provider networks. Performs claims repricing, discount analyses, etc. to support group sales efforts and RFPs. Provides understanding of financial impact based on history. Measures accuracy of projections. •Analyzes effectiveness of provider network performance through financial modeling, network accessibility and evaluate outcomes compared to expectations. •Analyzes employer group claims history to project discounts in support of group sales opportunities. Performs other discount and RFP questionnaire support related to provider contract and network value. •Performs analysis of financial information focused on unit price and performance-based payment methods financial effect allowing MMO to effectively negotiate with provider networks. •Plans and evaluates current network performance to determine effectiveness and assist in development and implementation of system enhancements by defining business requirements to ensure MMO's competitive advantage. •Provides tactical support and recommendations to contracting by assisting with analyses, projects, etc. Supports negotiation and contract interpretation and compliance. •Work on various special projects and ad-hoc reports on an as needed basis. Limited peer review and training. •Performs other duties as assigned. Senior Provider Analyst Provides analytical support during contract negotiation process. Assists contracting in building tools that model rate. Performs claims repricing, discount analyses, etc. to support group sales efforts and RFPs. Provides understanding of financial impact based on history. Measures accuracy of projections. Coordinates, guides, and monitors, as well as performs, the analytical review of opportunities with provider and national networks. •Provides tactical and strategic support and recommendations to contracting by assisting with analyses, projects, etc. Supports negotiation and acts as a consultant in efforts to establish market competitiveness and ensure 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. Operational and analytical oversight of value-based incentive contracts. Often requires coordination among multiple business areas. •Performs and develops analysis of financial information focused on unit price trend drivers, methodologies to transfer risk and other performance-based payment methods allowing effective negotiation with networks. Collects and analyzes information related to cost and quality transparency efforts for multiple audiences including, providers and consumers. •Utilizes research and decision-making tools to identify financial trends/patterns to assure the availability of information needed to analyze effectiveness of network performance, model proposed changes, and evaluate financial outcomes compared to expectations. •Analyzes employer group claims history to project discounts in support of group sales opportunities. Performs other discount and RFP questionnaire support related to provider contract and network value. •Maintains project-level responsibility for projects and deliverables through collaboration with other analyst(s) and support staff. Provides peer review, training and limited oversight. •Performs other duties as assigned. Lead Provider Analyst Primary point of analytical support for complex and cross-functional projects and/or program strategy deliverables to track and manage medical costs via various provider reimbursement methods including performance-based agreements such as bundled payments and shared savings as well as complex fee for service agreements. Provides analytical support during contract negotiation process. Provides understanding of financial impact based on history. Measures accuracy of projections. Coordinates, guides, and monitors, as well as performs, the analytical review of opportunities with provider networks. •Performs strategic data analysis (data mining) and research as appropriate to support contractual relationships and reimbursement methods between payers and providers, including global and bundled payments, and other value-based reimbursement methods and risk sharing arrangements. Provides tactical negotiation support and acts as a consultant in efforts to establish market competitiveness and ensure 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 competitive advantage. Operational and analytical oversight of value-based incentive contracts. Often requires coordination among multiple business areas. •Coordinates monitors and participates in the analysis of healthcare claim data focused on unit price trend drivers, methodologies to transfer risk and other performance-based payment methodologies allowing effective negotiation with provider networks. Devises analytic methodologies to deliver creative, meaningful, and actionable results to providers. •Develops research and decision-making tools to identify financial trends/patterns to assure the availability of information needed to analyze effectiveness of provider network performance, model proposed changes, and evaluate financial outcomes compared to expectations. •Schedules, assigns and monitors projects to the Analyst(s) and support staff to ensure the successful development and implementation of network performance initiatives. Limited or indirect supervisor or leadership responsibility over a group. Provides peer review, training and oversight. •Synthesizes information and imparts personal knowledge related to cost and quality transparency efforts for multiple audiences including, providers and consumers. •Performs other duties as assigned. Qualifications Provider Analyst II •Bachelor's degree in business administration, economics, statistics, IT, related field or equivalent work experience. Advanced degree preferred. •3 years of 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. •Strong analytical skills to thrive in a fast-paced environment as well as be comfortable with management exposure. Senior Provider Analyst •Bachelor's degree in business administration, economics, statistics, IT, or related field or equivalent combination of training and experience. •Master's degree preferred. •5 years health care consulting, provider contracting, or provider reimbursement experience or full proficiency in these areas. •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. Lead Provider Analyst •Bachelor's degree in business administration, economics, statistics, IT, mathematics, or related field or equivalent combination of education and work experience. •Master's degree preferred. •7 years health care consulting, provider contracting, or provider reimbursement experience. •Demonstrated experience and knowledge of systems applications and implementations, including spreadsheet and database applications. SAS knowledge preferred. •Strong mathematical aptitude with a demonstrated ability to make quantitative and analytical assessments, forecasts and projections. •Demonstrated ability to organize significant amounts of information into external facing documents. •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:

• 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.