Be an early applicantLess than 25 applicants

Company

Medical Mutual · 3 hours ago

Provider Reimbursement Analyst

United States

Full-time

Remote

Entry, Mid, Senior Level

7+ years exp

Maximize your interview chances

Health CareHealth Insurance

Culture & Values

Hiring Manager

Cassandra Sanders, PHR

Insider Connection @Medical Mutual

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

Analyzes contracted rates to assist with determining appropriate rates for provider contracts. Coordinates with Actuaries and Underwriting to determine how contracted rates will impact appropriate regions.

Works on various projects related to the analysis of claims, clinical and financial data, with a focus on improvement of financial and/or clinical outcomes.

Collaborates within the organization to perform ad hoc analysis as assigned.

Prepares monthly contract performance results and related financial reporting including interpretation and recommendations for improvement.

Prepares short- and long-range financial forecasting and related financial planning processes related to contract revenues and performance.

Orients, trains, and assists more junior level Analysts. May participate in interviewing and recommendations for hire, performance management and training and development of staff. Approve recommendations on increasingly complex professional and ancillary negotiations.

Analyzes payer value-based contract opportunities, including pay for performance, population health, gain or risk sharing, bundled payments, and other emerging payment models to support the organizations drive toward alternative payment models.

Analyzes and creates provider incentive distribution programs, including the periodic reporting of results, annual distribution calculations and budgeting. Supports the development of innovative distribution models to increase physician and practice engagement in quality improvement initiatives and outcomes.

Provide quality assurance of provider rate loading.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Provider Reimbursement Analyst experienceProvider Contracting/Network ManagementFinancial analysisMicrosoft Office ExcelSASSQLRelational databasesFinancial forecastingPayment modelingMicrosoft Office WordMicrosoft Office AccessMicrosoft Office PowerPointBusiness intelligence toolsMentoring

Required

Bachelor’s degree in business or healthcare administration, finance, accounting, or related field.

2 years of experience as a Provider Reimbursement Analyst or equivalent health care administration experience, preferably in managed care.

Provider Contracting/Network Management experience a plus.

Intermediate Microsoft Office Excel, Word, Access, and PowerPoint skills.

Working knowledge of SAS and/or SQL; knowledge of writing queries and analytical reports preferred.

Experience working with relational databases.

Knowledge of provider contracting.

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.

5 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting/Network Management.

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 business intelligence tools.

7 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting/Network Management.

Ability to mentor junior analysts.

Ability to apply technical skills and operational knowledge to produce actionable results and analysis.