Description
This role is hybrid in Cleveland, Ohio.
Responsibilities
Working under direct to general supervision, monitors the Company's provider network with respect to quality and utilization performance standards. Develops standard reporting and analytics to support Value Based Contracting (VBC) initiatives. Assists in supporting the contracting regions with quality, utilization, and cost analysis.
Provider Network Performance Analyst I
- Gathers and maintains data from multiple sources and conducts quality assurance to identify potential errors or inconsistency.
- Creates monthly reporting package for distribution to VBC providers.
- Develops standardized PowerPoint presentations incorporating comparative analysis for Joint Operating Committee (JOC) meetings with providers.
- Assists with contract amendment development and review processes.
- Analyzes VBC Provider performance on a monthly basis through creation and maintenance of monthly dashboard.
- Collaborates with other departments to align value based contracting initiatives.
- Performs other duties as assigned.
Provider Network Performance Analyst II
- Conducts quality assurance analysis on data from multiple sources to identify potential errors or inconsistency.
- Develops Value Based Contract (VBC) amendments in collaboration with legal and assists with managing the amendment review and negotiation process with the contract representatives.
- Analyzes quality and utilization results as compared to contractual targets and project financial payments for accrual on a monthly basis.
- Analyzes final performance results and creates annual year over year VBC program performance information.
- Creates monthly reporting package for distribution to VBC providers.
- Develops standardized PowerPoint presentations incorporating comparative analysis for Joint Operating Committee (JOC) meetings with providers.
- Analyzes VBC provider performance on a monthly basis through creation and maintenance of monthly dashboard.
- Collaborates with other departments to align value based contracting initiatives.
- Performs other duties as assigned.
Provider Network Performance Analyst III
- Develops Value Based Contract (VBC) amendments in collaboration with legal and assists with managing the amendment review and negotiation process with the contract representatives.
- Conducts quality assurance analysis on data from multiple sources to identify potential errors or inconsistency.
- Analyzes quality and utilization results as compared to contractual targets and project financial payments for accrual on a monthly basis.
- Analyzes final performance results and creates annual year over year VBC program performance information.
- Works directly with contracting reps to problem solve VBC issues or questions from providers.
- Creates monthly reporting package for distribution to VBC providers.
- Develops standardized PowerPoint presentations incorporating comparative analysis for Joint Operating Committee (JOC) meetings with providers.
- Analyzes VBC provider performance on a monthly basis through creation and maintenance of monthly dashboard.
- Collaborates with other departments to align value based contracting initiatives.
- Orients, trains, and assists more junior level Analyst.
- Performs other duties as assigned.
Senior Provider Network Performance Analyst
Monitors and oversees the Company's provider network with respect to quality and utilization performance standards. Provides necessary data to support contracting initiatives for the Provider Engagement (PE) department while working to implement value based contracting arrangements. Makes recommendations on process improvement opportunities with respect to performance against Value Based Contracting goals and objectives.
- Develops and implements value based contracting arrangements.
- Analyzes and evaluates the performance of provider contracts to identify opportunities related to improvement of value based arrangement in the areas of HEDIS, Stars, and other quality/utilization related performance.
- Monitors the performance of provider contracts for compliance to contractual arrangements associated with value based contracting and makes recommendations for improvement.
- Develops and presents current performance information to VBC providers and internal stakeholders.
- Serves as subject matter expert to internal and external stakeholders for the Value Based Contracting program.
- Develops standardized language and provides responses for Request for Proposal (RFP) questions pertaining to Value Based Contracting.
- Collaborates with other departments to align value based contracting initiatives.
- Orients, trains, and assists more junior level Analyst(s).
- Performs other duties as assigned.
Qualifications
Provider Network Performance Analyst I
Education and Experience:
- Bachelor's degree in healthcare administration, business, or related field.
- Value based contracting program experience in a health plan a plus.
Technical Skills and Knowledge:
- Good communication and organizational skills.
- Intermediate Microsoft Office and database reporting skills.
- Basic knowledge of health care operations or health care delivery systems.
Provider Network Performance Analyst II
Education and Experience:
- Bachelor's degree in healthcare administration, business, or related field.
- 2 years of experience as a Provider Network Performance Analyst or equivalent experience in a health plan.
Technical Skills and Knowledge:
- Good communication and organizational skills.
- Intermediate Microsoft Office and database reporting skills.
- Knowledge of insurance concepts, plan administration, planning, principles, and managed care delivery systems.
Provider Network Performance Analyst III
Education and Experience:
- Bachelor's degree in healthcare administration, business, or related field.
- 3 years of experience as a Provider Network Performance Analyst or equivalent experience in a health plan.
Technical Skills and Knowledge:
- Strong communication and organizational skills.
- Intermediate to advanced Microsoft Office and database reporting skills.
- Basic knowledge of SAS.
- Strong knowledge of insurance concepts, plan administration, planning, principles, and managed care delivery systems.
- Knowledge of common/standard Value Based Contracting components and principles.
Senior Provider Network Performance Analyst
Education and Experience:
- Bachelor's degree in healthcare administration, business, or related field.
- 5 years as a Provider Network Performance Analyst or equivalent experience in provider contracting/relations or health plan organization.
Technical Skills and Knowledge:
- Comprehensive knowledge of insurance concepts, plan administration, planning, principles, and managed care delivery systems and the ability to apply to company operations.
- Knowledge of payer performance based contracting.
- Strong communication and presentation skills.
- Advanced Microsoft Office and database reporting skills.
- Basic knowledge of SAS.
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.
- Whether you are working remote or in the office, 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.
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.
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