Aetna Network Account Manager in Downers Grove, Illinois
Req ID: 37884BR
Network Account Manager - IL Health Plan
Develops strong relationships with network providers and internal business partners leading to the achievement of provider satisfaction, medical cost targets, network growth and/or efficiency targets
(*) Executes strategic components of the HCD business plan for each market.
() Coordinates with segment constituents on medical cost and membership growth and network fortification initiatives. () Communicates with external constituents to effectively engage the provider community and demonstrate the Aetna value proposition.
(*) Manages medical cost drivers and executes specific medical cost initiatives to support financial and medical cost objectives.
(*) Proactively identifies new trends and products within Aetna and the industry and works to raise awareness throughout the organization in order to gain consensus on a course of action and ultimately drive to implementation.
() Consistently monitors Aetna service capabilities to collaboratively ensure that provider constituents needs are met. () Seeks to optimize provider interaction and provides recommendations based on balance of provider needs and Aetna's objectives.
(*) Responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers, and delivery systems.
(*) Interacts with large, high profile groups and providers to facilitate solutions that are mutually beneficial for both providers and the organization.
(*) Collaborates cross-functionally on more complex issues to ensure provider needs are met and outstanding issues are resolved. i.e. provider service efficiency, provider service improvement initiatives, identifies opportunities for process improvement.
(*) Collaborates with internal team members on the implementation of large, high profile physician groups, IPAs, PHOs and hospital systems to ensure a positive business relationship.
(*) Strong understanding of HFS and CMS reimbursement methodology
(*) Claims and revenue cycle experience critical
(*) 2-5 years industry experience. (Medical Cost Drivers and Managed Care Industry)
(*) Analytical/data driven decision-making skills
(*) Presentation skills
(*) Strong analytical and written/oral communication skills.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Claims/Policies & procedures/1-3 Years
ADDITIONAL JOB INFORMATION
Experience with Ancillary (DME, Dialysis, Lab, etc.) and LTSS/MLTSS providers preferred
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.
Job Function: Health Care