Aetna Operational Accounting (OA) Consultant in Harrisburg, Pennsylvania

Req ID: 38992BR

This position has potential for telework for existing Aetna teleworkers. In addition, you could work out of any of our service operations strategic sights: Albany NY, Allentown PA, Harrisburg PA, Cranberry PA, Arlington TX, Bismarck ND, High Point NC, Jacksonville FL, New Albany OH, Newark DE, Phoenix AZ, or Sandy, UT.

POSITION SUMMARY

Provide best in class shared services to internal and external constituents in a cost effective manner for all products and segments. Perform timely and accurate operational and transactional accounting, plan sponsor and internal funding, forecasting and reporting for claims, claim overpayment recoveries, premiums/fees and accounts receivable. Performs various intermediate-level operational/financial activities in support of revenue or claim information.

Fundamental Components:

The responsibilities include various functions within the root cause team focusing on different processes including, but not limited to, identifying new root cause concepts, managing ongoing projects, providing root cause analysis, analyzing and interpreting OPT data, collaborating with business partners for resolution of claim overpayment issues, and managing and providing reporting for constituent files. Some of these functions include:

Reviews and analyzes contract management reimbursement terms and policy/payment rules; identifies improper payments made to physicians, hospitals and other medical providers.Investigates medical claim data in conjunction with insurance payer contracts to identify payment errors. Extensive utilization of data mining technologies to identify payment issues. Provides subject matter expert (SME) consultation and advice in some functional areas of responsibility, providing recommendations on workflows, policies, components of systems and in daily operations and productsShares business knowledge and participates in the training and guidance of less-experienced staff members; exercises latitude to deviate from standard policies and procedures within established limits.Fosters and supports collaboration across organizations and builds strong and effective work relationships; works with internal and external constituents and business owners by providing subject matter expertise to resolve reconciliation discrepancies, implements process improvements and enhanced workflows.Provides accurate, timely and insightful analysis in response to ad hoc requests and issues. Utilizes technical skills to streamline and improve existing processes. Trouble-shoots problems and provides solutions based on practices, existing precedents or procedures.

BACKGROUND/EXPERIENCE desired:

3+ years experience claims processing experience, with proficiency on ACAS or HMO system, or like capability

Strong analytical/investigative skills

Strong Excel and/or WEBI skills

Ability to organize/manipulate large data sets

Excellent verbal and written communication skills

Flexible and able to adapt to changing priorities

Self-starter and able to work independently

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Claims/Claim processing - Medical or Hospital - ACAS/1+ Years

Functional - Claims/Claim processing - Medical or Hospital- HMO/1+Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/TE Microsoft Excel/1+ Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

General Business/Maximizing Work Practices/ADVANCED

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

General Business/Communicating for Impact/ADVANCED

Leadership/Collaborating for Results/ADVANCED

Service/Providing Solutions to Constituent Needs/ADVANCED

Telework Specifications:

Position is available to existing WAH; internal applicants already located in Allentown PA, Blue Bell PA, or Hartford CT; or to applicants located in Albany NY, Harrisburg PA, Cranberry PA, Arlington TX, Bismarck, ND, High Point NC, Jacksonville FL, New Albany OH, Newark DE, Phoenix AZ, or Sandy UT.

ADDITIONAL JOB INFORMATION

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.

Job Function: Customer Service