Provider Reimbursement Analyst

Overview

Medical Mutual employees must submit their applications through MySource.

Note:
This is a hybrid role requiring 3 days per week on-site in our Brooklyn, Ohio office. Seeking applicants that reside within a 50-mile radius of the Brooklyn, Ohio office.

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.

Performs routine to moderately complex financial analyses to support provider contracting strategies for Professional Providers. Begins to gain exposure to Institutional Provider analytics. Collaborates with Network Management and senior analysts to deliver actionable insights that support business initiatives and decision-making. Maintains market intelligence and contributes to the evaluation of network performance.

Provider Reimbursement Analyst II

• Analyze utilization, cost, contract valuation, competitive benchmarks, and financial impact data as directed. Translate findings into clear, actionable insights to support decision-making.
• Update and validate provider rate loading to ensure accuracy and compliance with contract terms.
• Provide tactical support to senior analysts by extracting and preparing data for robust quantitative analysis.
• Extract and manipulate data from multiple sources to develop analytic datasets. Present findings in a clear and concise format.
• Support rate strategy development and analyze emerging payment models to inform contracting decisions.
• Assist in forecasting contract rates and utilization trends. Build basic financial models and "what-if" scenarios using claims data.
• Support fee schedule development and quality checks. Maintain clear documentation of updates and build processes.
• Performs other duties as assigned.

Provider Reimbursement Analyst III

• 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.
• Performs other duties as assigned.

• 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.
• Develops, builds and quality checks Institutional Reimbursement Methodologies, ensuring documentation around each build is clear and repeatable. Documents what Methodologies need to be updated when.
• Forecasts contract rates, utilization trends and creates financial models using claims and other healthcare data. Creates "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…