Professional Reimbursement Analyst

Medical Mutual•Cleveland, OH

5d•Hybrid

About The Position

Medical Mutual is seeking a Professional Reimbursement Analyst to perform financial analyses supporting provider contracting strategies. This hybrid role requires 3 days per week on-site in our Brooklyn, Ohio office. Medical Mutual, founded in 1934, is a leading health insurance company in Ohio, providing a range of insurance plans to over 1.2 million members. The analyst will collaborate with Network Management and senior analysts to deliver actionable insights, maintain market intelligence, and contribute to network performance evaluation. The role involves analyzing utilization, cost, contract valuation, and financial impact data, translating findings into clear insights, extracting and manipulating data, and updating provider rates. Responsibilities may include supporting forecasting, developing financial models, and contributing to rate strategy discussions.

Requirements

Bachelor’s degree in business or healthcare administration, finance, accounting, or related field.
Equivalent education and experience directly related to the role may substitute for a degree.
Intermediate proficiency in Microsoft Excel, Word, Access and PowerPoint.
Basic knowledge of business intelligence tools.
Beginner-level experience with Databricks, and/or SQL; ability to adjust canned queries preferred.
Basic understanding of healthcare and/or health insurance.
Strong verbal and written communication skills.
2 years of experience as a Provider Reimbursement Analyst or equivalent health care administration experience, preferably in managed care.
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.
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.
Ability to apply technical skills and operational knowledge to produce actionable results and analysis.
5 years of experience as a Provider Reimbursement Analyst or equivalent progressive health care administration experience with an emphasis on Provider Contracting/Network Management.

Nice To Haves

Provider Contracting/Network Management experience a plus.

Responsibilities

Analyze utilization, cost, contract valuation, and financial impact data as directed.
Translate findings into clear, actionable insights.
Extract and manipulate data from multiple sources to develop analytic datasets.
Present findings in a clear and concise format.
Update provider rates and perform quality assurance on rate loads completed by other analysts.
Provide analytic support for provider profiling and comparative performance metrics.
Assist in forecasting contract rates and utilization trends.
Support development of basic financial models and 'what-if' scenarios.
Learn and support rate strategy discussions by preparing data and identifying opportunities for improvement under guidance from senior analysts.
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.
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.

Benefits

Laptop, monitors, keyboard, mouse and headset provided.
Access to on-site fitness centers or gym membership reimbursement.
On-site cafeteria at Brooklyn, OH headquarters.
Discounts at local businesses.
Opportunity to earn cash rewards for shopping with customers.
Business casual attire, including jeans.
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.
Access to an Employee Assistance Program.
Company holidays.
Up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
Parental leave for eligible employees.
Career development programs and classes.
Mentoring and coaching.
Tuition reimbursement up to $5,250 per year.
Diverse, inclusive and welcoming culture with Business Resource Groups.