Aetna Network Representative in W. Sacramento, California

Req ID: 37986BR

POSITION SUMMARY

Perform intake triage and respond to network inquiries including provider requests (e.g., policy and procedures, credentialing status, claims status, provider leads, etc.), internal customer requests, and member requests. Provide ongoing support to department members in completing research and analysis to resolve concerns/issues raised by providers and other internal/external customers

Fundamental Components:

Contacts providers by telephone, mail, or in person to solicit participation in the network. Explains the network and its requirements for participation; answers questions and communicates benefits of joining the network.

Coordinates telemarketing and direct mail campaigns to expand the provider and hospital networks within an assigned market area to meet specific demographic, geographic and/or specialty objectives.

Responds to and resolves provider questions, requests for information, and contractual interpretation inquiries in a timely manner.

Reviews provider applications and applies standard procedures for credentialing provider applications.

Maintains accurate provider information in the database.

Manages new and existing provider group relationships including data management issue resolution and annual audits.

May perform research, rate analysis, and data analysis for market and hospital development as necessary.

May assist with individual and group physician recruitment.

Performs other duties as required.

Provide ongoing support to department members in completing research and analysis to resolve concerns/issues raised by providers and other internal/external customers.

BACKGROUND/EXPERIENCE desired:1-3 years in Provider Relations is strongly preferred. Demonstrated ability to handle multiple assignments competently, accurately and efficiently.

Strong analytical and written/oral communication skills.

Associates or BS degree or 0 to 2 years experience directly related to the duties and responsibilities specified or an equivalent combination of education and work experience.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Network Management/Provider relations/1-3 Years

Functional - Network Management/Contract negotiation/1-3 Years

Functional - Network Management/Physician recruiting - medical/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Operating Systems/Windows/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User

ADDITIONAL JOB INFORMATION

Previous related business or health care experience required, preferably in provider relations, database management, provider credentialing, or provider recruitment capacity.Excellent verbal and written communication skills.

Proficiency with desktop software applications such as e-mail, Word and Excel.

Must be able to organize and analyze data.

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