Aetna Provider Relations Representative (53320BR) in Downers Grove, Illinois

Req ID: 53320BR

Aetna Better Health of IL is hiring a Provider Relations Representative to support our IL Plan.

Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs.

Fundamental Components:

(*) Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.

(*) Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.

(*) Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination. Performs credentialing support activities as needed.

(*) Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.

(*) Meets with key providers periodically to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings.

(*) May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.

(*) May provide guidance and training to less experienced team members.

BACKGROUND/EXPERIENCE desired:

(*) 3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.

(*) Working knowledge of business segment specific codes, products, and terminology.

(*) 3-5 years' experience with business segment specific policy, benefits, plan design and language.

(*) Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.

(*) Must be knowledgeable with Ancillary specialty (DME, Transportation, LABs and Dialysis).

EDUCATION

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

FUNCTIONAL EXPERIENCES

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

Functional - Network Management/Provider data services/1-3 Years

Functional - Customer Service/FE Customer Service - Provider - Traditional/1-3 Years

TECHNOLOGY EXPERIENCES

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

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 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.

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.

#LI-MR1

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.