Aetna Provider Claims Educator in Kenner, Louisiana
Req ID: 38989BR
This is an office based role in Kenner, LA.
Provider Claims Educator is fully integrated with Aetna Better Health of Louisianas appeals and grievances, medical management, claims processing, and provider relations departments and facilitates the exchange of information between these departments and providers.
Fundamental Components include but are not limited to:
The Provider Claims Educator must have a minimum of five (5) years experience working in a health care setting or a managed care company.
The person in this role must be an expert in claims processing and possess an in-depth understanding of the State of Louisiana Medicaid contract. Experience with and knowledge of fee schedules, coding, industry standard billing practices, and claims editing is preferred.
Educating in-network and out-of-network providers (i.e., professional and institutional) regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available Aetna Better Health resources such as provider manuals, websites, fee schedules, etc
Interfacing with various departments within Aetna Better Health to compile, analyze, and disseminate information from provider calls
Identifying trends and guiding the development and implementation of strategies to improve provider satisfaction
Frequently communicating (i.e., telephonic and on-site) with providers to ensure the effective exchange of information and to gain feedback regarding the extent to which providers are informed about appropriate claims submission practices
Working knowledge/background in SQL
Questions processes and suggests improvements
Demonstrates a sense of empathy, flexibility and creativity informed by cultural knowledge
Finds shortcuts and options to address atypical provider situations
Clearly and effectively expresses ideas both verbally and in writing
Adapts communications to meet the needs of the intended audience
Demonstrates curiosity and imagination when identifying issues and pursuing solutions
Effectively identifies problems based on review of performance data or expected results
Conducts focused examination of issues to identify root cause problem
Crafts and considers options for solving root cause problems
Applies technology to improve business processes and compliance
Implements solutions to resolve issues and monitors effectiveness of those solutions
Evaluates major issues, interfaces, potential pitfalls, and risks
Identifies and quantifies risks of alternative solutions
Ability to influence others to prioritize work is essential.
Demonstrated knowledge of medical cost drivers and managed care industry.
5 years experience in healthcare or managed care industry.
Ability to adjust to changing priorities and balance the ideal with the practical in achieving results.
A commitment to coaching and collaborating.
Ability to build and manage relationships to secure necessary resources not under direct control.
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Claims/Reporting & special services/3 years minimum
Claims/Policies & procedures/4-6 Years
Claims/Payment management/3-5 Years
Claims/Claims Administration - cost management/3-5 Years
Technical - EDI/EDI/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Health Care