Aetna Sr Director, Strategic Program in Blue Bell, Pennsylvania
Req ID: 43645BR
Dynamic leadership position within the NextGen Product/Network/Claim Enablement and Configuration team, responsible for leading a team in the full conversion, implementation, and maintenance of Aetna's provider contract and pricing requirements as needed to accurately price all claims on the NextGen systems platform, specifically, Health Rules Payor (HRP). As the lead over the Contract Pricing Enablement and Configuration team, you will be responsible for the timely and accurate delivery of all provider pricing requirements. You will guide the development of all business requirements, and lead the conversion of contracts from Aetna Core systems including Strategic Contract Manager/Pricer, and the Coventry IDX/CPD systems to HRP. Your team will also manage the daily synchronization of contracts in HRP back to Core books of record, you will collaborate to manage production support issues impacting claim adjudication, and work cross functionally to identify and prioritize workflow adjustments, systems enhancements, etc., as needed to successfully manage the positions scope.
Success in this position will require leadership focused on: cross functional collaboration with numerous areas including Network, Product, Claim, Legal/Compliance, Medical Policy, and other segment leaders to ensure identification, definition, and delivery of all required business requirements as needed to convert and configure provider contracts in HRP; effective prioritization and strong project leadership of numerous complex projects, many with competing priorities, making decisions based on strategy, line of business, business impact, and/or regulatory guidance, all with direct impact on business results and/or member and provider satisfaction; the identification and effective prioritization of system enhancement opportunities, ongoing development and enhancement of business tools, business workflows, controls and reporting; development and guidance of all team members and multiple other managers influencing your work, in the delivery of timely and accurate solutions. A knowledge of Aetna contract pricing methodologies and core applications a plus to support the conversion to HRP; and knowledge of SAS and Data Studio helpful in guiding the development of detailed SCM DAD and RPDB queries. You will oversee the ongoing development and timely execution of the daily process to ensure contract data synchronization between books of record and HRP. You will manage in collaboration with Product and Claim, production support issues impacting our ability to accurately service our Providers and Members. You will ensure adequate processes and controls over the quality review of contracts in preparation for integrated claim testing, and for support of production processing.
Proven track record demonstrating effective management of multiple and complex projects with on-time, on budget delivery; 10+ years of experience with at least 3 - 5 years experience leading and developing team members; prior experience in Network systems or development, provider contracts/fee schedule/pricing development in preferably Aetna systems, and/or claims processing background a plus.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Provider connectivity/4-6 Years
Functional - Project Management/Cross-functional project management/4-6 Years
Functional - Claims/Claim processing - Medical - Medicare/1-3 Years
Functional - Leadership/Lead a major product launch/4-6 Years
Technical - Aetna Applications/Strategic Contracts Manager/4-6 Years/End User
Technical - Aetna Applications/Strategic Pricer/4-6 Years/End User
Technical - Aetna Applications/Enterprise Provider Database System/1-3 Years/End User
Technical - Network///
Leadership/Collaborating for Results/MASTERY
Leadership/Developing and Executing Strategy/MASTERY
General Business/Communicating for Impact/MASTERY
Leadership/Engaging and Developing People/MASTERY
Flexible telework / office-based schedule (must live near certain office location)
ADDITIONAL JOB INFORMATION
We are looking for a dynamic, energetic leader to join a cross functional, multi-disciplined organization responsible for the conversion, development, and maintenance of complex data and/or compliance requirements in support of all Product, Network, and Claim functions for the NextGen platform. The environment is fast-paced, challenging and ever changing. This is an opportunity to use your skills and to develop both professionally and personally while supporting a challenging growth initiative for Aetna.
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: Management