Aetna Provider Relations Rep-40464BR-Harrisburg, Mechanicsville or Pittsburgh in Mechanicsburg, Pennsylvania
Req ID: 40464BRPOSITION SUMMARY
This role can work is open to a candidate who is living in the Harrisburg, Mechanicsville or Pittsburgh area. This role has 50% travel within those counties and the potential for telework for the remaining time.
Responsible for maintaining working relationships with the existing provider network. Assists providers with policy and procedure interpretation. Maintains accurate and current databases relating to provider facilities and physician information. May assist with physician recruitment.
Maintains regular contact with key provider organizations and serves as a liaison to internally resolve complex issues; develops strong interpersonal relationships with assigned providers.
Researches and resolves incoming escalated provider inquiries within contract guidelines; educates providers on new protocols, policies, and procedures.
Assists with physician recruitment as necessary by identifying specific providers within a designated territory, facilitating the distribution of provider agreements, negotiating rates for new physicians, and renegotiating contracts for existing physicians within established limits.
Conducts provider office site visits as necessary to ensure site meets contract guidelines.
Ensures provider database and documentation is up-to-date, accurate, and complete; ensures new physician contracts are entered promptly and accurately.
Assists with the development and implementation of provider training programs.
Performs other related duties as required.
Minimum of 3 years recent and related customer service experience with exposure to benefits interpretation 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.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Option for telework will be evaluated after a certain period of employment
ADDITIONAL JOB INFORMATION
· Covering the Counties of:o Cambria, Somerset, Bedford, Blair, Clearfield, Huntingdon, Mifflin, Juniata, Fulton, Franklinoro Berks, Lebanon, Lancaster, York, Adams
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.
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Job Function: Health Care