Aetna Network Operations Consultant in Chicago, Illinois
Req ID: 54512BR
Serves as the subject matter expert in support of contracting initiatives and provider data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for reviewing, building and auditing complex contract and network data, support recruitment efforts, and collaborate on negotiations as needed.
Responsible for reviewing provider data, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems.
Conducts research, analysis and/or provider data audits to identify issues and propose solutions to protect data, contract integrity and performance. Provides technical expertise for questions related to contracting and related systems and information contained.
Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration and rate activities. May coordinate complex contracting activities, implementation, coordinate receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.
Collaborates on negotiations or may handle contracting and re-contracting discussions with solo providers or small groups.
May conduct or assist with service activities such as provider education, technology usage, or process updates.
May recruit providers in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets .
Strong communication, critical thinking, problem resolution and interpersonal skills.
Knowledge of basic negotiating skills desired.
Proven working knowledge of standard provider contracts, terms and language desired.
3 years related experience.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Full-Time Telework (WAH)
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.
Aetna takes our candidates'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
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.