Provider Contract Support Specialist at Medical Mutual · Location…

Provider Contract Support Specialist

Medical Mutual employees must submit their applications through MySource.

Note: This is a hybrid role requiring 3 days per week on-site in our West Chester, Ohio office.

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.

Under general supervision, supports provider contracting department by developing and maintaining familiarity with assigned provider account/territory and their designated office staff, and fielding phone and e-mail inquiries. Prioritizes and researches issues affecting providers and maintains contract management files and documentation.

Responsibilities:

Provider Contract Support Specialist

• Follows up and tracks agreements and amendments in document management systems for approval. Uploads correspondence, and maintenance documents into document management system. Researches and/or routes issues to the Provider Data area and workflow queues for resolution.
• Answers inquiries from providers; resolves and/or refers issues regarding credentialing, claims, or other to the appropriate Provider Contract Manager or internal department; performs data entry and logs correspondence into contract management system.
• Assists in spreadsheet/report development for network adequacy and/or fee schedule review.
• Assists in the preparation of Joint Operating Committees with major health systems.
• Performs other duties as assigned.

Senior Provider Contract Support Specialist

• Follows up and tracks agreements and amendments in document management systems for approval. Uploads correspondence, and maintenance documents into document management system. Researches and/or routes issues to the Provider Data area and workflow queues for resolution.
• Answers inquiries from providers; resolves typically more complex and/or refers issues regarding credentialing, claims, or other to the appropriate Provider Contract Manager or internal department; performs data entry and logs correspondence into contract management system.
• Assists in typically more complex spreadsheet/report development for network adequacy and/or fee schedule review.
• Coordinates the preparation and scheduling of Joint Operating Committees with major health systems.
• Participates and/or facilitates departmental systems user training and testing. Orients, trains, and assists more junior level contracting staff.
• Performs other duties as assigned.

Qualifications:

Provider Contract Support Specialist

Education and Experience:

• Associate Degree in Business Administration or related field required.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 2 years of experience in health care or a health plan setting, including provider contracting, payment structures, claims, or related experience.

Technical Skills and Knowledge:

• Intermediate Microsoft Office skills (especially Excel).
• Knowledge of contract management and claims processing systems.
• Good oral and written communication skills with the ability to prepare general correspondence.
• Basic knowledge of health plan operations.

Senior Provider Contract Support Specialist

Education and Experience:

• Associate Degree in Business Administration or related field required.
• Equivalent education and experience directly related to the role may substitute for a degree.
• 1 year experience as a Provider Contract Support Specialist or 4 years of equivalent experience in health care or a health plan setting, including provider contracting, payment structures, claims, or related experience.

Technical Skills and Knowledge:

• Intermediate to advanced Microsoft Office skills (especially Excel).
• Strong knowledge of contract management and claims processing systems.
• Strong oral and written communication skills with the ability to prepare general correspondence.
• Strong knowledge of health plan operations.
• Strong research and problem-solving skills.
• Good research and problem-solving skills.

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.
• 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.