Provider Contract Support Specialist

Provider Contract Support Specialist

Note: This position will be hybrid (in-office & work from home).The Provider Contract Support Specialist position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Rossford, OH Medical Mutual 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 1.6 million Ohioans 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.

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 and help our members achieve their best possible health and quality of life.

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.

Sr. 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:

• Bachelor’s Degree in Business Administration or related field preferred, but will consider collective experience, training, and education.

• 3 years of experience in health care or a health plan organization, which includes exposure to Provider Contracting and/or provider payment structures and health insurance claims, or equivalent relevant 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.

• Good research and problem-solving skills.

Sr. Provider Contract Support Specialist

Education and Experience:

• Bachelor’s degree in business administration or related field preferred, but will consider collective experience, training, and education

• Minimum 1 year experience as a Provider Contract Support Specialist or equivalent 5 years of experience in health care or a health plan organization, which includes exposure to Provider Contracting and/or provider payment structures and health insurance claims, or equivalent relevant 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.

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:

• Top Workplace in Northeast Ohio. Year after year we've received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

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