Provider Network Performance Analyst (Hybrid - Cleveland, Ohio)

Medical Mutual of Ohio • Brooklyn, OH

401d • Hybrid

About The Position

The Provider Network Performance Analyst role at Medical Mutual of Ohio is a hybrid position based in Cleveland, Ohio, focused on monitoring and analyzing the company's provider network performance in relation to quality and utilization standards. The analyst will support Value Based Contracting (VBC) initiatives by developing reports, conducting quality assurance, and collaborating with various departments to enhance provider performance and compliance with contractual agreements.

Requirements

• Bachelor's degree in healthcare administration, business, or related field.
• 2-5 years of experience as a Provider Network Performance Analyst or equivalent experience in a health plan, depending on the level of the position.
• Good communication and organizational skills.
• Intermediate to advanced Microsoft Office and database reporting skills.
• Basic knowledge of SAS and healthcare operations or delivery systems.

Nice To Haves

• Experience with Value Based Contracting programs in a health plan.
• Knowledge of insurance concepts, plan administration, and managed care delivery systems.

Responsibilities

• Monitor the Company's provider network for quality and utilization performance standards.
• Develop standard reporting and analytics to support Value Based Contracting (VBC) initiatives.
• Assist in supporting the contracting regions with quality, utilization, and cost analysis.
• Gather and maintain data from multiple sources and conduct quality assurance to identify potential errors or inconsistencies.
• Create monthly reporting packages for distribution to VBC providers.
• Develop standardized PowerPoint presentations for Joint Operating Committee (JOC) meetings with providers.
• Analyze VBC provider performance on a monthly basis through the creation and maintenance of monthly dashboards.
• Collaborate with other departments to align value-based contracting initiatives.
• Conduct quality assurance analysis on data from multiple sources to identify potential errors or inconsistencies.
• Analyze quality and utilization results compared to contractual targets and project financial payments for accrual on a monthly basis.

Benefits

• Health savings account
• Disability insurance
• Health insurance
• Dental insurance
• Tuition reimbursement
• Paid time off
• Parental leave
• Employee assistance program
• Vision insurance
• 401(k) matching
• Gym membership

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree