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 1.6 million Ohioans 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.

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 and help our members achieve their best possible health and quality of life.

Under general supervision, performs typically routine to moderately complex initial and ongoing practitioner, provider, and organization data entry and credentialing into the various modules of the Provider Data Management System. Ensures compliance with standards set by individual states, federal and accrediting organizations and meets production and quality metrics.

Responsibilities

Provider Credentialing & Data Specialist II

· Retrieves applications and/or data from central repositories for provider data. Accesses various external websites, internal matrices, and contacts organizations to verify accuracy of information provided. Identifies whether application and/or document is clean or requires further review and routes to appropriate area. Enters verified data into the Provider Data Management Systems.

· Electronically contacts providers and/or internal departments when data is incomplete. Works with internal staff members, provider office staff, academic entities and/or other health related entities to obtain additional information.

· Generates reports from system for prioritization of work queue.

· Evaluates and researches practitioners that do not meet network participation criteria or are found to have on-going sanction monitoring issues. Gathers and summarizes information for Credentialing Committee or Provider Contracting and responds to questions as needed.

· Researches questions for accreditation or regulatory audits.

· Supports special projects as needed.

· Performs other duties as assigned.

Sr. Provider Credentialing & Data Specialist

· Retrieves applications and/or data from central repositories for provider data. Accesses various external websites, internal matrices, and contacts organizations to verify accuracy of information provided. Identifies whether application and/or document is clean or requires further review and routes to appropriate area. Enters verified data into the Provider Data Management Systems.

· Electronically contacts providers and/or internal departments when data is incomplete. Works with internal staff members, provider office staff, academic entities and/or other health related entities to obtain additional information.

· Documents and summarizes complex issues found in review to Credentialing Committee or Provider Contracting and responds to questions. May attend Committee meetings to respond to questions and records meeting minutes.

· Generates reports from system for prioritization of work queue.

· Evaluates and researches practitioners that do not meet network participation criteria or are found to have on-going sanction monitoring issues. Gathers and summarizes information for Credentialing Committee or Provider Contracting and responds to questions as needed.

· Researches and responds to questions for accreditation or regulatory audits.

· Supports special projects as needed.

· Orients, trains and assists more junior level staff.

· Performs other duties as assigned.

Qualifications

Provider Credentialing & Data Specialist II

Education and Experience:

• Associates Degree in Business or Healthcare Administration or related field, or equivalent combination of education/training (minimum high school diploma or GED) and experience.

• 1 year of experience as a Provider Credentialing & Data Specialist or equivalent experience in a health plan, medical office, hospital or similar administration.

Technical Skills and Knowledge:

• Intermediate Microsoft Office (Word, Excel), database reporting, OnBase (document management system), and internet navigation skills.

• Knowledge of provider credentialing and/or database management procedures.

• Strong data entry skills.

Sr. Provider Credentialing & Data Specialist

Education and Experience:

• Bachelors’ Degree in Business or Healthcare Administration or related field preferred, but will consider collective experience, training and education.

• 2 years progressive experience as a Provider Credentialing & Data Specialist or equivalent experience in a health plan, medical office, hospital or similar administration.

Technical Skills and Knowledge:

• Intermediate to advanced Microsoft Office (Word, Excel), database reporting, OnBase (document management system), and internet navigation skills.

• Advanced knowledge of provider credentialing and/or database management procedures.

• Strong data entry skills.

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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