Aetna Network Representative in Phoenix, Arizona

Req ID: 38085BR

POSITION SUMMARY

Review and submit requests to update the provider module within the QNXT system for adds/changes related to Mercy Maricopa and Mercy Care Plans. Fast paced environment with great team diversity.

FUNDAMENTAL COMPONENTS

-Based on information from new contracts, expansion efforts, and routine provider changes, research the requests for updates to ensure they meet CMS and AHCCCS regulations for member utilization.

-Standard data elements for provider data is used to feed member directories, claim adjudication, encounter submissions, and regulatory utilization reports

BACKGROUND/EXPERIENCE DESIRED

-Demonstrated ability to handle multiple assignments competently, accurately and efficiently.

-Strong analytical and written/oral communication skills.

-Associates or BS degree or 2+ years experience directly related to the duties and responsibilities specified or an equivalent combination of education and work experience.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Claims/Policies & procedures/1+ Years.

Functional - Network Management/Provider data services/1+ Years.

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/QNXT/1+ Years/End User.

Technical - Network/Provider services/1+ Years/End User.

Technical - Operating Systems/Windows NT/4-6 Years/Power User.

REQUIRED SKILLS

Service/Working Across Boundaries/ADVANCED.

General Business/Maximizing Work Practices/ADVANCED.

DESIRED SKILLS

Leadership/Collaborating for Results/FOUNDATION.

Technology/Leveraging Technology/FOUNDATION.

TELEWORK SPECIFICATIONS

Option for telework will be evaluated after a certain period of employment.

Telework considered only for unique circumstances.

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