Aetna Negotiator Consultant in Plymouth, Minnesota
Req ID: 40728BR
Primary purpose of this position is to lead and manage the mission of obtaining the highest possible success rates and reductions on provider claims/bills which result in savings to both the client and the insured.
Reviews outpatient and professional claims/bills $2,000 and under to determine negotiation strategy and potential savings.
Capability, on a daily basis, to work in a production environment reviewing and negotiating 45-50 incoming claims/bills per day.
Organizes and prioritizes incoming claims/bills to ensure client criteria are maintained (example: turn around time) and established internal goals are met.
Works with all departments to obtain information such as plan benefits and insured liability, to assist in the negotiation process.
Handles phone and written inquiries from providers related to pre and post negotiations.
Investigates and resolves issues surrounding pre and post negotiated claims/bills.
Reviews provider and claim history to assist in determining appropriate percentage reduction for negotiation based upon established guidelines for claims/bills $2,000 and under.
Contacts the provider via phone and fax as set forth under the established guidelines for claims/bills $2,000 and under.
Working knowledge of all lines of business including but not limited to Medical and Workers' Compensation.
Strives to develop and maintain provider relationships.
Documents system with information pertinent to claim/bill and provider.
Reviews claims/bills to initiate Long Term Agreements and Master Contracts.
Maintains and utilizes all resource material and systems to effectively manage job responsibilities.
Independently reviews and determines resolution for claim/bill issues and concerns.
Exhibits the following Negotiator Consultant Behaviors
Contract Negotiation within healthcare environment is REQUIRED; 2-3 years.
Experience in a production environment.
Customer service experience.
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
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: Claim