Provider Contract Manager

Medical Mutual•Rossford, OH

2d•Hybrid

About The Position

Medical Mutual is seeking to hire a Provider Contract Manager. This is a hybrid role, with a preference for candidates located in the Northwest, OH region. Medical Mutual, founded in 1934, 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 health, life, disability, dental, vision, and indemnity plans. The company offers a range of group coverage options, including Medicare Advantage, Medicare Supplement, and individual plans. The Provider Contract Manager role involves developing and maintaining relationships with providers, developing the provider network through contracting and relationship management, and facilitating education and issue resolution. The specific responsibilities and qualifications vary depending on the level of the role (I, II, III, or Senior).

Requirements

Bachelor’s Degree in Business or Healthcare Administration, Finance, or related field. In lieu of Degree, may consider an equivalent combination of education and experience.
Intermediate Microsoft Office skills, especially Excel.
General knowledge of the health care industry and current events.
Good project management skills.
Knowledge of provider contract negotiations, regulations, etc.
Good presentation skills.
Intermediate to advanced Microsoft Office skills, especially Excel and PowerPoint.
In depth knowledge of the health care industry and current events.
Strong project management skills.
Thorough knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value-based concepts.
Strong presentation skills.
Strong financial acumen.
Comprehensive knowledge of the health care industry and current events.
Strong project management skills.
Comprehensive knowledge of provider contract negotiations, regulations, contract and provider reimbursement models, and value-based concepts.
Strong presentation skills.
Strong financial acumen.
5 years of progressive experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field.

Nice To Haves

Experience in health insurance or a health care related field preferred.
2 years of experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field.
3 years of experience as a Provider Contract Manager or equivalent experience in health insurance or a health care related field.

Responsibilities

Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff.
Explains contract provisions to internal/external customers.
Prepares non-standard contracts, amendments, and extensions.
Conducts non-standard contracts, rate, and language negotiations.
Compiles and analyzes data to support contracting negotiations and/or compliance.
Serves as a communication link between assigned providers and the Company.
Provides provider service and education, including field visits.
Collaborates on issues related to billing, pricing, policy, and reimbursements.
Serves as a point of contact for other internal departments (including Payer Relations, A/R, Billing, and Revenue Cycle) regarding assigned providers or National Networks and issues that may impact assigned providers.
Collaborates with other areas within Provider Engagement on Joint Operations Committee (JOC) meetings of health systems and/or National Ancillary provider groups and/or National Networks, preparing agenda and meeting minutes.
Identifies program/system enhancements to reduce/minimize issues going forward.
May collaborate with other key areas on cross functional projects.
Performs other duties as assigned.
Researches and resolves complex issues that may impact future negotiations or jeopardize network retention.
Reviews financial impact analyses, projections and develops negotiation work papers.
Makes recommendations to assist in complex negotiations.
Provides coaching and mentoring to more junior Provider Contract Managers and support staff.
Manages contracts for off cycle relationships that are initiated during non-renewal periods.
Negotiates non-standard contracts independently.
Performs in-depth review of data and financial analysis supplied to Contracting.
Serves as a subject matter expert and communication link between all assigned providers or National networks and the Company.
Provides provider service and education, including field visits and seminars.
Collaborates with other key area on cross functional projects.
Orients, trains, assists and reviews work of more junior Provider Contract Managers and support staff.
Negotiates and reviews complex non-standard contracts to improve and/or keep competitive positioning that have the most strategic importance to the company.
Compiles and interprets financial data necessary to support contracting negotiations and/or compliance and draws conclusions to make informed decisions.
Takes independent action within established departmental guidelines.
Acts as Hospital/PHO, Ancillary, National Network relationship manager by assisting assigned providers with contract, claims, systems, education, and other concerns.
Manages market areas by recommending and helping to implement strategies for the market.
Participates and/or takes the lead in most challenging internal or external projects.
Assists management with special projects.

Benefits

Laptop, monitors, keyboard, mouse and headset provided.
Access to on-site fitness centers or gym membership reimbursement.
On-site cafeteria at 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.
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.