Aetna Provider Data Consultant in Champaign, Illinois
Req ID: 60546BR
Provides support for provider data transactions associated with projects, expansions, and new product implementations. Resolves high volume/high impact systemic problems through proactive and reactive mechanisms (e.g. automation, route audit programs, data reporting, root cause analysis).
Fundamental Components included but are not limited to:
Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, rework and audit trends) and recommends process improvements.
Establishes, maintains and aligns complex contracted provider demographic data and negotiated reimbursement arrangements across provider systems.
Creates and manages action plans for assigned projects relative to data quality and/or workflow improvements.
Ensures that all impacted constituents are considered and appropriately addressed in action plans.
Provides technical and/or functional leadership within unit (i.e., team lead).
Performs validation of system enhancements. Extract information from provider systems to meet business reporting needs (i.e., DAF reports, fee schedule reports, Service Center Log.
Qualifications Requirements and Preferences:
5+ years of experience and knowledge of Provider Data Services systems and other end user applications.
1-2 years provider credentialing and data management experience
Bachelor's degree or equivalent and 3+ years of relevant experience preferred.
1-2 years of project management experience helpful
Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
General Business - Communicating for Impact, General Business - Maximizing Work Practices, Service - Handling Service Challenges
General Business - Turning Data into Information, Leadership - Collaborating for Results, Service - Working Across Boundaries
Additional Job Information:
Large project reviews included but not limited to reconciliation of network ids and directory flags. Processing newly credentialed providers by linking with executed contracts and submitting for load into the system.
We receive reports from different areas on the company and are required to validate the information.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.