Aetna Senior Project Manager in Chicago, Illinois

Req ID: 44351BR

POSITION SUMMARY

The Senior Project Manager is a dynamic position within the Next Gen Provider Contract/Pricing team, responsible for implementing accurate conversion of provider contracts to Health Rules Payor (HRP). As part of the Product, Network, and Claim Configuration team, you will be responsible to research and define the business requirements in support of required pricing features and to configure provider contract provisions to support the many functions within the Next Gen business administrative platform, Health Rules Payor (HRP). Accurate provider pricing configuration is critical to claims adjudication, and ultimately, having satisfied consumers and providers. By working closely with other areas of the company such as network, product, claims, legal/compliance, medical policy, and/or segment leaders this position will be responsible to ensure the correct decisions are made when configuring contract and pricing features.

Fundamental Components:

In this position you will be responsible to ensure Aetnas Next Gen provider contracts, rates, and pricing systems are configured accurately and timely, and synchronized with Core system books of record to drive a positive provider and member experience. To do this successfully, you will:

-research and define the needed business requirements sourced from provider and contract databases to support accurate provider pricing in Health Rules Payor (HRP);

-review new and existing provider contracts to determine the most effective programming logic needed to facilitate accurate and consistent provider pricing; collaborate cross-functionally and closely with business analysts, testers, developers, and members of the Next Gen Product and Claim teams to ensure the provider pricing conversion logic from SCM to HRP supports the business;

-contribute to the development and timely execution of the daily maintenance of provider contracts needed to keep contracts synchronized to Core and to continue accurate claim pricing;

-assist with triaging provider pricing issues in production, reviewing claims and providing guidance to stakeholders on accurate provider pricing;

-identify and escalate as needed provider pricing issues with potential to adversely impact service levels;

-review and test the provider contracts auto-converted from SCM to HRP; ensure the necessary remediation of issues, create and execute test plans, and participate or initiate audits of provider contracts

-document decisions, workflows, controls, and business process as reference to support sustainability of the provider pricing function within HRP.

BACKGROUND/EXPERIENCE:

Solid Project Management and supervisory skills; at least 4 years of practical experience.

Proven track record in meeting project milestones and negotiating for resources.

Proven communication skills both written and verbal

Past experience includes development of budgets

Past positions required acting a project lead and directing a team

Proven ability to affect change/interpersonal skills

Problem solving skills

Good business acumen; professional communication skills.

EDUCATION

The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES

  • Project Management/Issue identification and analysis/4-6 Years

  • Claims/Claim processing - Medical or Hospital- HMO/1-3 Years

    • Claims/Claim processing - Medical or Hospital - ACAS/1-3 Years

    • Network Management/Provider data services/4-6 Years

    TECHNOLOGY EXPERIENCES

  • Aetna Applications/Enterprise Provider Database System/4-6 Years/End User

  • Aetna Applications/Strategic Contracts Manager/4-6 Years/End User

    Telework Specifications:

    Considered only for current internal teleworkers (in any area)

    ADDITIONAL JOB INFORMATION

  • Nationwide opportunity, must be near an Aetna office location.

    Aetna is about more than a job. This is an opportunity to use your skills and to develop professionally while supporting a new challenging initiative at Aetna, helping drive the future growth of the company.

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Management