Aetna Senior Analyst in Richmond, Virginia

Req ID: 45109BR

No Telework; Candidate can work from Phoenix, AZ, Pittsburgh, PA, Newark, DE or Richmond, VA office.

POSITION SUMMARY

Creates and executes deliverables as part of a team assigned to a business. This position supports the Medicaid Encounter processes including new plan implementations, system upgrades, and regulatory changes by plan. The Analyst is responsible for defining the reporting requirements based on each state specifics and working with Data Base Analysts to ensure the report requirements are met.

Fundamental Components:

*Candidate is responsible for the creation and submission of encounter data to State entities in accordance with regulatory and contractual requirements for accuracy and timeliness. *Prepare, validate, submit, load, and log 837 encounter files and 277, 824, 999, NCPDP response files in accurate and timely manner according to state and federal regulations. *Resolves problems in a timely and effective manner. *Understands the impact of actions on system primarily used/maintained. *Understands relationships of designated systems. *Analyzes and verifies system results to ensure accuracy, accountability and financial data integrity. *Analyzes and resolves system error conditions within established unit time frames. *Participates as a member of a project team.

BACKGROUND/EXPERIENCE desired:

At least one year of HIPPA (837 File) experience is REQUIRED.

*Technical savvy *Familiarity with SQL helpful. *Knowledge of 837 institutional and professional file structure is a plus. *Background in claims, root cause analysis and / or health care. *Strong critical thinking skills *Strong analytical skills *Strong communication skills *Strong problem solving skills

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Information Technology/Computer operations/1-3 Years

Functional - Information Technology/Research/1-3 Years

Functional - Information Technology/Testing/1-3 Years

Functional - Claims/Reporting & special services/1-3 Years

Functional - Information Management/Business information analysis/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Database/Microsoft SQL Server/1-3 Years/End User

Technical - EDI/EDI/1-3 Years/End User

Technical - Aetna Applications/QNXT/1-3 Years/End User

Technical - System Management/Problem Management/1-3 Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/FOUNDATION

General Business/Communicating for Impact/ADVANCED

General Business/Maximizing Work Practices/ADVANCED

DESIRED SKILLS

General Business/Turning Data into Information/ADVANCED

Service/Working Across Boundaries/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

If you want the challenge of working in a dynamic environment, this is the position for you. This position will allow you to work with a diverse team of individuals and allow a candidate to acquire a wide variety of knowledge ranging from the inner-workings of an 837 EDI health care claim file to an introduction to the use of SQL. Each day is different from the previous day as there are multiple work streams that need to be managed concurrently.

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