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Aetna Provider Data Services Consultant in Kenner, Louisiana

Req ID: 67261BR

Job Description

Provides support for provider data transactions associated with projects, expansions, and new product implementations. Resolves high volume/high impact systemic problems through proactive and reactive mechanisms (e.g. automation, route audit programs, data reporting, root cause analysis).

Fundamental Components included but are not limited to:

  • Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, rework and audit trends) and recommends process improvements.

  • Establishes, maintains and aligns complex contracted provider demographic data and negotiated reimbursement arrangements across provider systems.

  • Creates and manages action plans for assigned projects relative to data quality and/or workflow improvements.

  • Ensures that all impacted constituents are considered and appropriately addressed in action plans.

  • Provides technical and/or functional leadership within unit (i.e., team lead).

  • Performs validation of system enhancements.

  • Extract information from provider systems to meet business reporting needs (i.e., DAF reports, fee schedule reports, Service Center Log.

Qualifications Requirements and Preferences:

  • 3+ Years of experience and knowledge of Provider Data Services systems and other end user applications.

  • 1-2 years of project management experience preferred

  • Bachelor's degree or equivalent

Benefit Eligibility

Benefit eligibility may vary by 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.

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