Aetna Cost Management Business Consultant in Denver, Colorado
Req ID: 49398BR
The Business Consultant for the Meritain Cost Management area will report to the Director of Meritain Cost Management. This candidate will be responsible for managing and approving high dollar medical costs referred to Cost Management as well as administering bill review services
*Managing medical costs that represent potentially high-dollar, high-risk, or high-visibility concerns to our clients and their membership requiring the analysis of cost, long-term and short-, and as needed, negotiating *Acting as the escalation point for negotiators, carrier coordinators, and specialty program managers, and be able to step in to address the detailed level of concerns addressed or manage any disputes *Evaluates medical claim submissions with a high level of detail to support cost containment measures as identified, and create an internal network of support to create efficient resolution to high risk items *Provide consultative support for our clients as it relates to the Meritain Cost Management programs, at a detailed level, and to negotiate, settle, or reconcile medical costs as it relates to Meritain members/clients *Manage and report data daily, via Excel, any of the various reporting needs, while managing staffs timelines for executing timely and risk-free cost-management programs through continued development and evaluations *Observe and enforce within the Cost Management team, a strict adherence to all necessary policies, regulatory or contractual, that place constraints or demands on claim payment as it relates to our active programs *Establish effective and clear communication to Meritains Client Solution teams to ensure an enhanced development of their clients needs to further develop those relationships for client retention purposes *Independently access necessary resources to formulate decision-making as it relates to carrier-related cost-containment through interaction of Claims area, Stop Loss, Client Relations, Quality Assurance, etc
*Detailed analytical medical claims background to include coding certification (CPC preferred), medical reimbursement policy, standard claim edits, usual and customary rules and standards, benchmarking, and industry standard reporting per CMS criteria
5+ years experience with one or more of the following methodologies: management consulting, project consulting, business process consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting.
Experience with moderate scale initiatives with moderate degree of complexity.
Operational experience in a relevant discipline.
Demonstrated superior business process, project management and organizational redesign experience.
Demonstrated experience successfully implementing change in complex organizations.
Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, strategic planning, risk management.
Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.
The highest level of education desired for candidates in this position is a Bachelor'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.
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Job Function: Management