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Job Information

Aetna Director, Provider Data Services in Philadelphia, Pennsylvania

Req ID: 69883BR

Job Description

Oversees a department with multiple provider data services units. Accountable for the overall delivery of provider data services including production, quality audit, reporting and process improvement for the business operation. Responsibilities include oversight for vendor resources supporting unit.

Fundamental Components included but are not limited to:

Oversees operational management of all provider data services functions. Manages units from 30-150Accountable for department initiatives, budget, financial results and objectivesBuilds and develops strong functional operation management team through formal training, diverse assignments, coaching, communication, mentoring and performance management. Accountable to hire, develop and fire staffCultivates and manages relationships with various external entities, e.g. vendors, large IPA/PHO's, etc Ensures all PDS policies and procedures are executed consistently across business operationDirects audit procedures used for maintaining accurate provider records essential for correct reimbursement, contractual compliance, and network directory listing purposes Creates process improvement strategy to address developing internal trends e.g. changes in others' roles, error trends and external constituent needs, e.g. provider requirements for dataDrives change through the organization to support competitive and changing environment (*)

Qualifications Requirements and Preferences:

Demonstrated knowledge of medical cost drivers and managed care industry. Bachelor's degree and 7 or more years of relevant experience preferred.

Required Skills:

Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Leadership - Creating Accountability

Desired Skills:

General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Driving Change

Additional Job Information:

Proven ability to work collaboratively at all levels.Ability to effect change.Exercises sound judgment and demonstrates analytical/data-driven decision making skills.Able to assess administrative, financial and constiuent impact of provider contracts.Understands provider contracts, contracting options, and operational issues related to provider relations.

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.