Provider Reimbursement Analyst

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.

Responsibilities

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.

Senior Provider 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.
• 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 conduct root cause analysis on inquiry data. Recommend system enhancements, targeted training, and process improvements to mitigate future errors and strengthen operational integrity.
• Performs other duties as assigned.

Lead Provider Reimbursement Analyst

• Mentor junior analysts and contribute to hiring, performance management, and training initiatives to build team capability and ensure analytical excellence.
• Provide expert guidance on routine to complex institutional negotiations, serving as a resource for best practices and quality assurance.
• 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.
• Maintain and enhance SOPs and policies, promoting standardization and operational efficiency across reimbursement processes.
• Partner with Actuaries and Underwriting to assess regional financial impacts of contracted rates and support short- and long-term forecasting.
• 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.
• Develop and refine complex deal models to support contracting efforts, leveraging advanced analytics and market intelligence.
• Interpret complex contract language to assess financial implications and support
• Lead quality assurance initiatives across reimbursement analytics and operational processes. Develop and implement QA frameworks to ensure accuracy, consistency and compliance in financial modeling, contract interpretation and rate loading activities. Collaborate with cross-functional teams to resolve discrepancies and continuously
• Performs other duties as assigned.

Qualifications

Provider Reimbursement Analyst II

Education and Experience:

• 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.

Technical Skills and Knowledge:

• 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.

Provider Reimbursement Analyst III

Education and Experience:

• Bachelor's degree in business or healthcare administration, finance, accounting, or related field.
• 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 Provider Reimbursement Analyst

Education and Experience:

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

Lead Provider Reimbursement Analyst

Education and Experience:

• Bachelor's degree in business or healthcare administration, finance, accounting, or related field. MBA Preferred.
• 7 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 analyses.
• Ability to mentor junior analysts.
• Experience working with relational databases.
• Ability to apply technical skills and operational knowledge to produce actionable results and analysis.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

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.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.