Medical Mutual Job - 43209567 | CareerArc
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Company: Medical Mutual
Location: Cleveland, OH
Career Level: Associate
Industries: Banking, Insurance, Financial Services


This position is work at home 

Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance, and other corporate quality initiatives. Develops and executes programs and processes that support the initiatives. Leverages analytics to improve the health and experience of members while lowering costs of care. Proposes and manages strategic projects for risk revenue and provider performance optimization


•Develops, coordinates and monitors outreach/intervention activities with providers to improve member outcomes, coding accuracy and quality results. 

•Develops education and incentive programs that are supported by data driven analytics and results.  Collaborates closely with Provider Contracting teams to ensure appropriate delivery approach and assist in the review of provider agreements.

•Acts as project manager over large internal risk adjustment projects (e.g., Optum In Office Assessment program for both MA and ACA, Diagnosis Gap Advisor for concurrent communication with providers regarding diagnosis documentation and claims submission).

•Manages vendor agreements to ensure optimal pricing and performance guarantees are included and enforced.  Reviews and reconciles vendor invoices.

•Prepares and presents reports and executive summaries to a variety of audiences.



•Bachelor's Degree in Nursing, Business or Healthcare Administration or related field. In lieu of degree, may consider equivalent combination of education/training and experience.

•3 years of experience in health care quality assurance, continuous improvement, case management or utilization review, which includes experience communicating with providers.

•Medical /clinical background highly desirable.

Professional Certification(s):

•Registered Nurse preferred

•Certified Professional Coder (CPC) preferred

Technical Skills and Knowledge:

•Strong knowledge of the MarketPlace and Medicare within a managed care insurance industry.

•Knowledge of Centers for Medicare & Medicaid Services (CMS) regulations pertaining to Medicare Advantage and Affordable Care Act.

•Knowledge of medical coding and billing procedures.

•Intermediate to advanced Microsoft Office (Word, Excel, and PowerPoint) skills.

•Strong presentation skills.

Behavioral Competencies

•Effective Communication  •Ability to Conceptualize     •Creates Partnerships

•Analytical Problem Solving          •Facilitates Change 


•Performs work in an office setting with moderate levels of noise, sitting for long periods of time, using computers and phones, and with exposure to fluorescent lighting.

•Ability to occasionally travel offsite.

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 80 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 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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