Medical Mutual · 2 months ago
Provider Contract Support Specialist
Cleveland, OH 44144, USA
Full-time
Hybrid
Mid, Senior Level
$44K/yr - $62K/yr
3+ years expMedical Mutual is the oldest and one of the largest health insurance companies based in Ohio, providing peace of mind to over 1.2 million members through various insurance plans. The Provider Contract Support Specialist will support the provider contracting department by managing provider accounts, fielding inquiries, and maintaining documentation related to contracts and provider issues.
Health CareHealth InsuranceInsuranceLife Insurance
Responsibilities
Follows up and tracks agreements and amendments in document management systems for approval. Uploads correspondence, and maintenance documents into document management system. Research and/or routes issues to the Provider Data area and workflow queues for resolution
Answers inquiries from providers; resolves and/or refers issues regarding credentialing, claims, or other to the appropriate Provider Contract Manager or internal department; performs data entry and logs correspondence into contract management system
Assists in spreadsheet/report development for network adequacy and/or fee schedule review
Assists in the preparation of Joint Operating Committees with major health systems
Performs other duties as assigned
Follows up and tracks agreements and amendments in document management systems for approval. Uploads correspondence, and maintenance documents into document management system. Research and/or routes issues to the Provider Data area and workflow queues for resolution
Answers inquiries from providers; resolves typically more complex and/or refers issues regarding credentialing, claims, or other to the appropriate Provider Contract Manager or internal department; performs data entry and logs correspondence into contract management system
Assists in typically more complex spreadsheet/report development for network adequacy and/or fee schedule review
Coordinates the preparation and scheduling of Joint Operating Committees with major health systems
Participates and/or facilitates departmental systems user training and testing. Orients, trains, and assists more junior level contracting staff
Performs other duties as assigned
Qualification
Required
3 years of experience in health care or a health plan organization, which includes exposure to provider contracting and/or provider payment structures and health insurance claims, or equivalent relevant experience
Intermediate Microsoft Office skills (especially Excel)
Knowledge of contract management and claims processing systems
Good oral and written communication skills with the ability to prepare general correspondence
Basic knowledge of health plan operations
Good research and problem-solving skills
Minimum 1 year experience as a Provider Contract Support Specialist or equivalent 5 years of experience in health care or a health plan organization, which includes exposure to provider contracting and/or provider payment structures and health insurance claims, or equivalent relevant experience
Intermediate to advanced Microsoft Office skills (especially Excel)
Strong knowledge of contract management and claims processing systems
Strong oral and written communication skills with the ability to prepare general correspondence
Strong knowledge of health plan operations
Strong research and problem-solving skills
Preferred
Bachelor's Degree in Business Administration or related field preferred, but will consider collective experience, training, and education
Company
Medical Mutual
Medical Mutual Provides and administers health benefits for citizens in Ohio.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Annette Terrien Hill
RNI Chief Operating Officer
Christopher Donovan
Executive Vice President, Chief Data and Information Officer
Recent News
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