Aetna Provider Data Svcs Cnslt in Louisville, Kentucky

Req ID: 54788BR

POSITION SUMMARY

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:

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.

BACKGROUND/EXPERIENCE desired:

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

1-2 years of project management experience.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Project Management/Issue identification and analysis/1-3 Years

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

Functional - Claims/Policies & procedures/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Network/Provider data management/1-3 Years/

REQUIRED SKILLS

General Business/Ensuring Project Discipline/FOUNDATION

Leadership/Anticipating and Innovating/FOUNDATION

Service/Working Across Boundaries/FOUNDATION

DESIRED SKILLS

General Business/Applying Reasoned Judgment/MASTERY

Leadership/Driving Strategic and Organizational Agility/MASTERY

Service/Handling Service Challenges/ADVANCED

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.