Aetna Medical Economics SrCnslt in Harrisburg, Pennsylvania

Req ID: 45403BR

POSITION SUMMARY

Outstanding opportunity for an experienced analyst, who likes to think outside of the box. The Medical Economics Sr. Consultant will be a part of the "SWAT Team" who is working on different Ad Hoc analyses and covering all Aetna-Coventry Markets.

Fundamental Components:

-Analyzes complex Capitation agreements and performs "what if" analyses based on numerous variables.

-Good communication skills and understanding of the health care industry are needed for coordination with Network and Actuarial teams to gather pertinent details and effectively present results/recommendations.

-Develops new Tools to automate current processes and improve accuracy and efficiency.

-Influences changes/enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access.

-Assigns CMS Medicare rates to claims for determining Medicare relativities/benchmarking.

-Supports high performance/narrow network, savings opportunities, and ad hoc reporting.

-Demonstrates initiative, innovation and leadership in achieving results.

-Retrieves, organizes and performs complex analysis on large data sets using MS Access/Excel and SAS/SQL.

BACKGROUND/EXPERIENCE desired:

5-8 years of experience in the managed care industry (preferably in a Medical Economics Department) with knowledge of provider contracting and provider reimbursement (Fee For Service, Per Visit, Capitation, etc.).

Minimum Bachelors in Math, Computer Science or some other related field.

Strong analytical ability and familiarity with advanced financial and healthcare concepts.

EDUCATION

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

TECHNOLOGY EXPERIENCES

Technical - Database/Microsoft Access/4-6 Years/Power User

Technical - Aetna Applications/Aetna Strategic Data Warehouse/4-6 Years/Power User

Technical - Reporting Tools/SAS/4-6 Years/Power User

ADDITIONAL JOB INFORMATION

The Medical Economics Sr. Consultant performs complex data mining and analyses, reporting, and contract modeling of physician groups and hospital systems for the Network Analytics and Actuarial teams. The consultant needs be able to understand complex payment methodologies and modify existing models to be more efficient and flexible. This is a position for somebody who is not afraid to work on non-standard projects, who likes challenge, who is creative and able to research data and find solutions to many different problems.

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: Health Care