Aetna Medicare Business Consultant in Overland Park, Kansas

Req ID: 44725BR

This position will sit in the Overland Park, KS office location.

POSITION SUMMARY

Serves as subject matter expert for the implementation of all Medicare Part D and Medicare Advantage activities and

programs across a market in support of the General Manager. Provides guidance and consultation for new product startup,

program design and regulatory compliance. Provides support for the Medicare Part D and Medicare Advantage

operational interface to ensure tactical business goals are achieved across the organization. Supports the CMS bid and

application activities.

Fundamental Components:

Serves as subject matter expert for the operational functions of Medicare products within an assigned market.

Assists with the execution of all CMS required activities and processes including the accuracy and compliance of the

annual bid application, expansion application, member materials, and group setup.

Supports internal and external Medicare audit activity including CMS and operation integrity audits. Coordinates file

pulls, data requests, universe development, and supporting documentation.

Maintains an awareness of trends, developments, and governmental regulations in Medicare and managed health

care organizations.

Provides consultative support for Medicare product design features, integration schedule, and operational readiness in

a new product start-up environment.

May participate on various committees to represent the Medicare Department including NCQA, Internal Research,

UM/QI, Trend/MER, Risk Mitigation, Complaint and Appeals, bid, implementation, and migration.

Supports member retention activities, including development of outreach materials, design/implementation of outreach

programs both directly and in coordination with corporate member retention team, development of talking points/

educational pieces about market specific issues.

Monitors sales and marketing activities to assure

BACKGROUND/EXPERIENCE desired:

Previous experience (5-7 years) in Medicare Operations and/or Medicare compliance functions.

Familiarity with regulations/statutes impacting the managed care environment.

Ability to perform analysis and legal research to identify and clarify issues.

Proficiency with corporate software applications, including MS Word, Excel, Outlook, PowerPoint, and special proprietary applications.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Administration / Operations/Data Entry/1-3 Years

Functional - Administration / Operations/Document production & distribution/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Computer Operations/System and Console Operations/1-3 Years/End User

Technical - Database//1-3 Years/System Support

ADDITIONAL JOB INFORMATION

Excellent consulting and leadership skills.

Excellent communication, interpersonal and presentation skills.

Able to effectively coordinate multiple projects and programs in a matrix environment and work independently.

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