Aetna Supervisor, Provider Relations in Charlottesville, Virginia

Req ID: 51194BR

POSITION SUMMARY

Assesses departmental and provider training needs; develops and implements appropriate training programs. Provides oversight of provider claims issues; coordinates and communicates resolution. Oversees the resolution of administrative problems affecting network providers, patients, and Plans within contracted guidelines; resolves problems and advises providers of new protocols, policies, and procedures.

Fundamental Components:

Mentoring Provider Network Liaisons. Listening to provider issues and working collaboratively with other departments to identify both root cause and creative solutions.

BACKGROUND/EXPERIENCE desired:

  • Minimum of 5 years recent and related experience in provider relations and claims.

  • Previous supervisory experience managing remote employees in multiple locations required.

  • Knowledge of ICD-9 and CPT codes required.

  • Excellent analytical and problem solving skills.

  • Strong communication skills.

  • Comfortable presenting in front of groups.

  • Ability to collaborate with other departments.

  • Excel and Powerpoint required.

  • Provider contracting experience is a plus.

  • Knowledge of QNXT a plus.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Claims/ is desired

Managed Care/ is desired

Aetna/ is desired

FUNCTIONAL EXPERIENCES

Functional - Claims//4-6 Years

Functional - Network Management/Provider relations/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/QNXT/1-3 Years/

Telework Specifications:

Must be within reasonable driving distance to any VA Aetna Better Health of VA office

ADDITIONAL JOB INFORMATION

This is a key position working directly with the Director of Network and Provider Relations as well as other leadership in key departments. This position will be working with and mentoring a great team of highly dedicated Provider Relations Liaisons. The Health Plan is in a growth mode and opportunity for growth is a benefit.

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.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care