Assists Contractors and Management by maintaining familiarity with each account and their designated representative(s), understanding provider contracts, and fielding calls/concerns that occur. In addition, prioritizes and researches problems affecting providers and maintains up to date contract and contract management files and documentation.
- Follows up and tracks new standard and non-standard contracts in OnBase for signature approval. Scans all relevant correspondence, credentialing applications and maintenance forms/documents into OnBase. Assists in the review of rosters to ensure correct formatting. Works and routes all issues in the Provider Registration and Contact On-line Reporting System (CORS) workflow queue to the appropriate person for resolution.
- Answers inquiries from providers in a competent, courteous and timely manner to resolve provider issues and ensure good service; refers provider issues as necessary to the appropriate Contracting Representative, management, or Department; logs all relevant correspondence into Goldmine.
- Assists in report development and special projects using knowledge of contracts and other information sources.
- Assists Contracting Representative in resolving credentialing issues or provider notifications. Prepares and mails out welcome letters to new providers.
- Updates rates into External Pricer and Modeling when applicable.
- Identifies overpayment/underpayment issues and assists Contracting Representative in resolution of specific provider issues, and identification and prevention of other related issues.
- Performs other duties as assigned.
- Bachelors' Degree in Business Administration or related field preferred, but will consider collective experience, training and education.
- Minimum of two (2) years healthcare industry experience required.
- Knowledge of basic computer skills, Q & A software, and MS Office skills.
- Able to prepare general correspondence and work with peer groups on special projects or task forces.
- Understands the general business flows, procedures and systems.
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.
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