Description
Note: In-office requirement (1) day per week in Brooklyn, Ohio.
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.
Responsibilities
Provider Contract Support Specialist
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.
- Follows up and tracks agreements and amendments in document management systems for approval. Uploads correspondence, and maintenance documents into document management system. Research 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
Under limited supervision, supports provider contracting department (typically more senior level Contractors) by developing and maintaining familiarity with assigned provider account/territory (typically key providers and major health care systems) 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.
- Follows up and tracks agreements and amendments in document management systems for approval. Uploads correspondence, and maintenance documents into document management system. Research 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
- 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.
- 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.
Senior Provider Contract Support Specialist
- 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.
- 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.
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