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.

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.

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.

• 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.