Provider Contract Manager

Medical Mutual employees must submit their applications through MySource.

This role is hybrid role, with a strong preference for candidates located in the Northwest, OH region.

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.

Provider Contract Manager I

Job Summary:

Under direct supervision, develops and maintains relationships with typically small to medium sized and/or moderately complex provider community via e-mail, telephonic and face to face outreach. Develops the provider network and national network offerings through contracting activities, relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and the resolution of provider issues.


Responsibilities:

• Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff. Explains contract provisions to internal/external customers.
• Prepares non- standard contracts, amendments, and extensions. With some assistance, conducts non-standard contracts, rate, and language negotiations.
• Compiles and analyzes data to support contracting negotiations and/or compliance.
• Serves as a communication link between assigned providers and the Company. Provides provider service and education, including field visits.
• Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers.
• Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes
• Identifies program/system enhancements to reduce/minimize issues going forward.
• May collaborate with other key areas on cross functional projects.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Bachelor's Degree in Business or Healthcare Administration, Finance, or related field.
• In lieu of Degree, may consider an equivalent combination of education and experience
• Experience in health insurance or a health care related field preferred.

Technical Skills and Knowledge:

• Intermediate Microsoft Office skills, especially Excel.
• General knowledge of the health care industry and current events.
• Good project management skills.
• Knowledge of provider contract negotiations, regulations, etc.
• Good presentation skills.

Provider Contract Manager II

Job Summary:

Under general supervision, develops and maintains relationships with typically medium to larger sized and/or complex provider community) via email, telephonic and face-to-face outreach. Develops the provider network and national network offerings through contracting activities, contract negotiations (language and rates), drafting contracts, amendments, and extension documents, managing relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and resolution of provider issues.


Responsibilities:

• Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff. Explains contract provisions to internal/external customers.
• Compiles and analyzes data to support contracting negotiations and/or compliance.
• Researches and resolves complex issues that may impact future negotiations or jeopardize network retention. Reviews financial impact analyses, projections and develops negotiation work papers. Makes recommendations to assist in complex negotiations.
• Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, driving the meetings in the discussions of issues and changes
• Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers.
• Serves as a communication link between all assigned providers or National networks and the Company. Provides provider service and education, including field visits.
• Collaborates with other key area on cross functional projects.
• Identifies program/system enhancements to reduce/minimize issues going forward.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Bachelor's Degree in Business or Healthcare Administration, Finance, or related field.
• In lieu of Degree, may consider an equivalent combination of education and experience.
• 2 years of experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field.

Technical Skills and Knowledge:

• Intermediate to advanced Microsoft Office skills, especially Excel and PowerPoint.
• In depth knowledge of the health care industry and current events.
• Strong project management skills.
• Thorough knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value- based concepts.
• Strong presentation skills.

Provider Contract Manager III

Job Summary:

Under minimal supervision, develops and maintains relationships with typically larger and/or more complex provider community (e.g., institutional, Physician Hospital Organization (PHO), primary care, multi-specialty, ancillary, national providers, health systems), via email, telephonic and face-to-face outreach. Develops the provider network and national network offerings through contracting activities, contract negotiations (language and rates), drafting contracts, amendments, and extension documents, managing relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and resolution of provider issues. Provides coaching and mentoring to more junior Provider Contract Managers and support staff.


Responsibilities:

• Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks, consultants, and internal department staff. Explains contract provisions to internal/external customers. Manages contracts for off cycle relationships that are initiated during non-renewal periods.
• Negotiates non-standard contracts independently.
• Researches and resolves complex issues that may impact future negotiations or jeopardize network retention. Reviews financial impact analyses, projections and develops negotiation work papers. Makes recommendations to assist in complex negotiations.
• Compiles and analyzes data to support contracting negotiations and/or compliance. Performs in-depth review of data and financial analysis supplied to Contracting
• Serves as a subject matter expert and communication link between all assigned providers or National networks and the Company. Provides provider service and education, including field visits and seminars.
• Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers
• Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes, driving the meetings in the discussions of issues and changes. Collaborates with other key area on cross functional projects.
• Identifies program/system enhancements to reduce/minimize issues going forward.
• Orients, trains, assists and reviews work of more junior Provider Contract Managers and support staff.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Bachelor's Degree in Business or Healthcare Administration, Finance, or related field.
• In lieu of Degree, may consider an equivalent combination of education and experience.
• 3 years of experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field.

Technical Skills and Knowledge:

• Intermediate to advanced Microsoft Office skills, especially Excel and PowerPoint.
• Comprehensive knowledge of the health care industry and current events.
• Strong project management skills.
• Comprehensive knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value- based concepts.
• Strong presentation skills.
• Strong financial acumen.

Sr Provider Contract Manager

Job Summary:

Under minimal supervision for decision making, develops and maintains relationships with typically the largest and most complex provider community via email, telephonic and face-to-face outreach. Develops the provider network and national network offerings through contracting activities, contract negotiations (language and rates), drafting contracts, amendments, and extension documents, managing relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and resolution of provider issues. Provides coaching and mentoring to more junior Provider Contract Managers and support staff and assists management with special projects.


Responsibilities:

• Negotiates and reviews complex non-standard contracts to improve and/or keep competitive positioning that have the most strategic importance to the company.
• Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks, consultants, and internal department staff. Explains contract provisions to internal/external customers. Manages contracts for off cycle relationships that are initiated during non-renewal periods.
• Researches and resolves complex issues that may impact future negotiations or jeopardize network retention. Reviews financial impact analyses, projections and develops negotiation work papers. Makes recommendations to assist in complex negotiations.
• Compiles and interprets financial data necessary to support contracting negotiations and/or compliance and draws conclusions to make informed decisions. Takes independent action within established departmental guidelines.
• Acts as Hospital/PHO, Ancillary, National Network relationship manager by assisting assigned providers with contract, claims, systems, education, and other concerns. Manages market areas by recommending and helping to implement strategies for the market.
• Participates and/or takes the lead in most challenging internal or external projects. Identifies and resolves program/system enhancements to reduce/minimize issues going forward.
• Serves as a subject matter expert and communication link between all assigned providers or National networks and the Company. Provides provider service and education, including field visits and seminars.
• Collaborates on issues related to billing, pricing, policy, and reimbursements. Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers.
• Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes, driving the meetings in the discussions of issues and changes
• Orients, trains, assists and reviews work of more junior staff.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Bachelor's Degree in Business or Healthcare Administration, Finance, or related field.
• In lieu of Degree, may consider an equivalent combination of education and experience.
• 5 years of progressive experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field.

Technical Skills and Knowledge:

• Intermediate to advanced Microsoft Office skills, especially Excel and PowerPoint.
• Comprehensive knowledge of the health care industry and current events.
• Strong project management skills.
• Comprehensive knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value-based concepts.
• Strong presentation skills.
• Strong financial acumen.

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.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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