Aetna Provider Relations Consultant - 60547BR in Champaign, Illinois
Req ID: 60547BR
Acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures.
Fundamental Components included but are not limited to:
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
Supports or assists with operational activities that may include, but are not limited to, database management, and contract coordination.
Performs credentialing support activities as needed.
Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
Meets with key providers periodically to ensure service levels are meeting expectations.
Manages the development of agenda, validates materials, and facilitates external provider meetings.
May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.
May provide guidance and training to less experienced team members.
Qualifications Requirements and Preferences:
3+ years' experience in business segment environment servicing providers with exposure to benefits, claims and/or contract interpretation.
3-5 years' experience with business segment specific policy, benefits, plan design and language preferred
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
Working knowledge of business segment specific codes, products, and terminology.
Bachelor s Degree or equivalent combination of education and experience.
Additional Job Information:
Servicing providers with their unresolved issues by researching and issues to determine the necessary steps for resolution of the issue within the terms of the providers contract while protecting the member.
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.