Aetna Senior Analyst in Newark, Delaware
Req ID: 55131BR
Candidate should be familiar with 837 EDI/ANSI X12/HIPAA transaction sets, claims processing and encounters
Should have ability to move multiple projects forward simultaneously and be responsible for the results even when others are directly accountable for the outcome.
Ability to establish effective business relationships with internal and external constituents a must
Candidate is responsible for the creation and submission of encounter data to State and federal entities in accordance with regulatory and contractual requirements for accuracy and timeliness
Resolves problems in a timely and effective manner
Escalates issues appropriately
Uses designated systems to obtain information
Understands the impact of actions on system primarily used/maintained
Understands relationships of designated systems
Analyzes and verifies system results to ensure accuracy, accountability and financial data integrity
Possesses working knowledge of functions of other units in department
Responds to and resolves customer inquiries and complaints (internal as well as external), both verbal and written correspondence within established unit time frames
Analyzes and resolves system error conditions within established unit time frames
Participates as a member of a project team
Analyzes and recommends solutions to nonstandard requests and requirements from plan sponsors and areas within and outside the area
Processes customer new business and other transactions and records in appropriate systems
Uses system produced data to prepare management level reports
Strong 837 experience required
Background in claims, root cause analysis and / or health care data
Strong critical thinking skills
Strong analytical skills
Strong organizational skills including the ability to manage tasks with competing priorities
Familiarity with SQL along with other HIPAA transactions and code sets helpful
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
Functional - Claims/Reporting & special services/1-3 Years
Functional - Administration / Operations/Data Entry/1-3 Years
Functional - Actuarial//
Technical - Aetna Applications/QNXT/1-3 Years/Power User
Technical - EDI/EDI/1-3 Years/End User
General Business/Applying Reasoned Judgment/FOUNDATION
General Business/Maximizing Work Practices/ADVANCED
General Business/Communicating for Impact/ADVANCED
General Business/Demonstrating Business and Industry Acumen/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
ADDITIONAL JOB INFORMATION
Opportunity for the right candidate to learn technical tasks in fast paced and highly regulated area.
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.