Aetna Network Operations Consultant in Jacksonville, Florida
Req ID: 62628BR
This position will support the Orlando Market in meeting contracting goals/initiatives by acting as a liaison to hospital systems/large provider groups. This role will be responsible for interfacing with providers and internal constituents to resolve provider issues. The ideal candidate will also be responsible for building and maintaining positive relationships with assigned providers.
Fundamental Components included but are not limited to:
Responsible for reviewing, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems. Conducts research, analysis and/or 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 .
Qualifications Requirements and Preferences:
3+ years related experience. Proven working knowledge of claims systems, coding, policies, state regulations, provider contracts desired. Strong communication, critical thinking, problem resolution and interpersonal skills. Bachelor s Degree or equivalent combination of education and experience.
Claim - Claim processing - Medical or Hospital- HMO, Network Management - Provider data services, Network Management - Provider relations
Desktop Tool - Adobe Acrobat Suite v5, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word
General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Service - Handling Service Challenges
Benefits Management - Interacting with Medical Professionals, General Business - Demonstrating Business and Industry Acumen, Sales - Negotiating Collaboratively
Additional Job Information:
Opportunity to work independently in a fast-paced environment with the potential for growth.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
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.