Aetna Provider Relation Liaison in Harrisburg, Pennsylvania

Req ID: 44063BR

POSITION SUMMARY

This role is an in office position with up to 25% travel within the counties of PA. This role can work from either the Philadelphia or Harrisburg PA office.

Develops, maintains, and enhances provider relationships in support of regional and national networking objectives. Responsible for the overall relationship management for assigned provider community.

Fundamental Components:

Responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers, and delivery systems (*)

Interacts with large, high profile physician groups, IPAs, PHOs and hospital systems to resolve disputes and find solutions that are mutually beneficial for both providers and the organization (*)

Builds strong relationships with providers and key contacts to support on-going negotiating efforts (*)

Finalizes routine contracts and recruitment arrangements with providers (*)

Understands medical cost drivers and executes specific medical cost initiatives to support operational objectives

Proactively identifies new trends within the industry and works to raise awareness throughout the organization in order to gain consensus on a course of action and ultimately drive to implementation (*)

Identifies opportunities for process improvement and works cross-functionally within the organization to gain desired outcomes regarding provider service issues

Accesses and coordinates highly sensitive member medical record content to meet QM and NCQA requirements (*)

May coordinate with Sales & Marketing to address high profile plan sponsor issues related to the network and identify provider educational opportunities

Monitors the ever-changing and competitive landscape of health care delivery and evaluates the potential to adopt and implement policies and procedures to keep Aetna at the lead or ahead of industry movements

Executes organizational strategy at the market level to meet and exceed company goals and objectives

BACKGROUND/EXPERIENCE:

Minimum of 2-3 years recent and related customer service related to Provider Networking with exposure to benefits interpretation to providers and provider networking.

Experience with managed care policy and direction, benefit plan design, and provider fee schedules desired, but not required.

Knowledge of ICD-9 and CPT codes desired

Demonstrated knowledge of medical cost drivers and managed care industry.

Proven ability to synthesize and translate competitive intelligence into decision-making process.

EDUCATION

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

ADDITIONAL JOB INFORMATION

This role is an in office position with up to 25% travel within the counties of PA. This role can work from either the Philadelphia or Harrisburg PA office.

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