Aetna Provider Claims Educator in Kenner, Louisiana

Req ID: 38989BR

This is an office based role in Kenner, LA.

POSITION SUMMARY

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.

BACKGROUND/EXPERIENCE

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.

EDUCATION

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

FUNCTIONAL EXPERIENCES

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

TECHNOLOGY EXPERIENCES

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