Hospital Reimbursement Analyst

Medical Mutual Hospital Reimbursement Analyst Medical Mutual is a leading health insurance company seeking a Hospital Reimbursement Analyst and Senior Hospital Reimbursement Analyst to work in hybrid mode (3 days on‑site in Brooklyn, Ohio). The role supports provider contracting strategies, data analysis, and financial modeling to enable network performance decisions. The successful candidate will collaborate with Network Management, senior analysts, and internal stakeholders to develop rates and negotiations. Responsibilities Hospital Reimbursement Analyst Develop complex deal models in collaboration with Network Management to support contracting. Analyze performance using utilization, cost, contract valuation, competitive benchmarks, and financial impact metrics. Communicate findings to support decision‑making. Support rate strategy development by identifying opportunities to optimize contracted rates and protect favorable structures through financial analysis. Update and validate provider rate loading to ensure accuracy and compliance with contract terms. Analyze emerging payment models and pricing strategies. Apply knowledge of commercial and Medicare reimbursement policies to inform contracting decisions. Provide tactical support to senior analysts by extracting, cleaning, and preparing data for robust quantitative analysis. Forecast contract rates and utilization trends. Build financial models and \"what-if\" scenarios using claims and healthcare data. Assist in building and validating rate methodologies. Ensure documentation is clear, repeatable, and aligned with update timelines. Interpret complex contract language to assess financial implications of proposed changes. Perform other duties as assigned. Senior Hospital Reimbursement Analyst Collaborate with Network Management to shape rate strategies and contract methodologies that optimize financial outcomes. Identify opportunities to enhance or safeguard favorable rate structures by analyzing the financial impact of corporate initiatives, including policy changes. Deliver strategic insights through clear communication of recommendations, analytical summaries, and presentations to senior leadership. Build and refine complex deal models in collaboration with Network Management to support contracting efforts. Apply advanced analytical techniques and business acumen to evaluate deal projections, benchmark performance, and assess financial impacts using utilization data, cost trends, contract valuation, and competitive analysis. Ensure accuracy and consistency in provider rate loading through regular updates and quality assurance reviews. Mentor and guide junior analysts, providing training, support, and quality oversight. Serve as a resource for resolving complex analytical and operational issues. Partner with Actuaries and Underwriting to assess regional financial impacts of contracted rates and support short‑ and long‑term forecasting. Develop, build, and quality check institutional reimbursement methodologies, ensuring documentation around each build is clear and repeatable. Document when methodologies need to be updated. Forecast contract rates, utilization trends, and create financial models using claims and other healthcare data. Create \"what-if\" scenarios to help guide analytical decision making. Interpret complex contract language to assess financial implications of proposed changes and support negotiation strategies. Investigate claim disputes to validate pricing accuracy and conduct root cause analysis on inquiry data. Recommend system enhancements, targeted training, and process improvements to mitigate future errors and strengthen operational integrity. Perform other duties as assigned. Qualifications Hospital Reimbursement Analyst Education and Experience Bachelor's degree in business, healthcare administration, finance, accounting, or a related field. Equivalent education and experience directly related to the role may substitute for a degree. 3–4 years of experience as a Provider Reimbursement Analyst or equivalent progressive health‑care administration experience with an emphasis on provider contracting/ network management. Technical Skills and Knowledge Intermediate Microsoft Office Excel, Word, Access, and PowerPoint. Working knowledge of SAS and/or SQL; knowledge of writing queries and analytical reports preferred. Ability to quickly learn and use software business intelligence tools. Experience working with relational databases. Senior Hospital Reimbursement Analyst Education and Experience Bachelor's degree in business, healthcare administration, finance, accounting, or a related field. Equivalent education and experience directly related to the role may substitute for a degree. 5 years of experience as a Provider Reimbursement Analyst or equivalent progressive health‑care administration experience with an emphasis on provider contracting/ network management. Technical Skills and Knowledge Advanced financial analysis skills including forecasting and payment modeling. Advanced computer skills including Excel, Word, Access, and PowerPoint. Ability to utilize SAS programming language in assigned analysis. Ability to quickly learn and use software BI tools. Experience working with relational databases. Ability to apply technical skills and operational knowledge to produce actionable results and analysis. Benefits 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. We maintain a drug‑free workplace and perform pre‑employment substance abuse and nicotine testing. Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Medical Mutual