Aetna Medicare Implementation Consultant in Overland Park, Kansas
Req ID: 51053BR
Serves as subject matter expert for the implementation of all Medicare Advantage activities and programs across a market in support of the Operations Department. Provides guidance and consultation for new product start-up, employer group setup, benefit implementation and regulatory compliance. Provides support for the Medicare Advantage Individual and Group operational interface to ensure tactical business goals are achieved across the organization. Supports the CMS bid and application activities.
Serves as subject matter expert for the operational functions of Medicare products within an assigned market.
Assists with the execution of all CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, and group setup.
Supports Medicare Claims/Member experience activities including Coordinates file pulls, data requests, universe development, and supporting documentation.
Maintains an awareness of trends, developments, and governmental regulations in Medicare and managed health care organizations.
Provides consultative support for Medicare product design features, integration schedule, and operational readiness in a new product start-up environment.
Supports internal departments that work with Medicare, including development of training materials, design/implementation of training programs both directly and in coordination with corporate member training team, development of talking points/educational pieces about market specific issues.
Performs other related duties as assigned.
Previous experience (1-3 years) in Operations, Claims, and/or Medicare compliance functions.
Familiarity with regulations and statutes impacting the managed care environment.
Ability to perform analysis and legal research to identify and clarify issues.
Ability to quickly learn and work in claims software applications, reviewing claims history, provider data, agent information, and explain benefit data to multiple audiences.
Able to effectively coordinate multiple projects and programs in a matrix environment and work independently.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Management/Management - Data tools: building and utilization/1-3 Years
Functional - Management/Management - Operations/1-3 Years
Functional - Management/Management - Medicare/1-3 Years
Functional - Management/Management - Claims/1-3 Years
Functional - Management/Management - Project management (non-IT)/1-3 Years
Technical - Database/Microsoft Access/1-3 Years/Administrator
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/Administrator
General Business/Applying Reasoned Judgment/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Demonstrating Service Discipline/FOUNDATION
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 candidate'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: Legal