Provider Contract Manager

***Note: To foster collaboration and ensure productive discussions, team members are expected to attend scheduled meetings in person at the office in Dublin, OH.

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, develops and maintains relationships with typically small to medium sized and/or moderately complex provider community (e.g., medical groups, ancillary) via e-mail, telephonic and face to face outreach. Develops the provider network and national network offerings through contracting activities, relationship development, and servicing. Communicates administrative and programmatic changes and facilitates education and the resolution of provider issues.

Responsibilities:

Provider Contract Manager I

· Prepares standard contracts, amendments, and extensions. With supervision or assistance, conducts non-standard contracts, rate, and language negotiations.

· Builds relationships with assigned territory of providers and with internal department staff.

· Serves as a communication link between assigned providers and the Company.

· Responds to provider issues related to billing, pricing, policy, and reimbursements.

· Understands and explains contract provisions to internal and external office personnel.

· Determines if providers were paid according to contract terms.

· Participates in internal and external projects.

· Performs other duties as assigned.

Provider Contract Manager II

· Builds relationships with assigned territory of providers, ancillary specialties, and/or national networks and with internal department staff. Explains contract provisions to internal/external customers.

· Prepares non- standard contracts, amendments, and extensions. With some assistance, conducts non-standard contracts, rate, and language negotiations.

· Serves as a communication link between assigned providers and the Company. Provides provider service and education, including field visits.

· Responds to issues related to billing, pricing, policy, and reimbursements.

· Determines if providers were paid according to contract terms.

· Identifies program/system enhancements to reduce/minimize issues going forward.