Aetna Credentialing Analyst in New York, New York
Req ID: 65893BR
Reviews, analyzes, evaluates, validates provider/producer information against business/credentialing requirements and maintains information in Credentialing data bases. Supports extensive research and analysis of sensitive provider/producer issues; addresses data integrity issues.
Fundamental Components included but are not limited to:
Maintains high production and quality factors.
Participates in development of credentialing processes and workflows.
Identifies improvement opportunities and recommends enhancements and workable solutions.
Provides telephonic education to providers/producers on credentialing policies and procedures.
Identifies and communicates trends (quality of results, efficiencies of processes).
Researches and prepares risk sensitive or complex business review/credentialing verification items for CPC.
Reviews completed investigative files of co-workers for completion and accuracy.
Manages vendor on-line access of primary verification sources.
Provides ongoing support to department members in completing research and analysis to resolve complex issues raised by providers/producers and other internal/external customers.
Directly contacts providers/producers and/or outside entities to clarify data quality issues.
Provides issue resolution for providers/producers, during the credentialing or data management processes.
Responds to network or provider/producer inquiries, including contracting and credentialing policy, procedures, credentialing status.
Perform data entry and systems maintenance as needed; align data across systems.
Ongoing License Sanction monitoring and reporting to minimize corporate risk.
Qualifications Requirements and Preferences:
Track record of prioritizing work, multi-tasking, and managing workload efficiently.
College degree or equivalent work experience preferred.
High School Diploma or G.E.D.
Additional Job Information:
Possesses a working knowledge of Business Review/Credentialing processes, EPDB, EPC and CARDS.
Ability to consistently meet and/or exceed performance/production goals.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
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.