Aetna Provider Data Services Consultant in Kenner, Louisiana
Req ID: 67261BR
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 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.