Aetna Veterans Jobs

Job Information

Aetna Encounter Validation Analyst in Newark, Delaware

Req ID: 67742BR

Job Description

Performs research and analysis of multiple data sources to meet business/clients needs. Gathers and documents business requirements into specifications for information products with management support.

Fundamental Components included but are not limited to:

  • Candidate is responsible for the creation and submission of encounter data to State and federal entities in accordance with regulatory and contractual requirements for accuracy and timeliness

  • Resolves problems in a timely and effective manner

  • Uses designated systems to obtain information

  • 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

  • Possesses working knowledge of functions of other units in department

  • Responds to and resolves customer inquiries and complaints (internal as well as external), both verbal and written correspondence within established unit time frames

  • Analyzes and resolves system error conditions within established unit time frames

  • Participates as a member of a project team

  • Analyzes and recommends solutions to nonstandard requests and requirements from plan sponsors and areas within and outside the area

  • Processes customer new business and other transactions and records in appropriate systems

  • Uses system produced data to prepare management level reports

  • Oversight for reporting on 1-3 Medicaid plans

  • Monitor, review, research, reconcile and balance designated Aetna system activity

Qualifications Requirements and Preferences:

  • Excellent verbal and written communication skills.

  • Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook) and Internet Explorer.

  • Strong organizational skills.3-5 years of data interpretation and analysis experience.

  • Basic programming skills (e.g., to run extracts).

  • Healthcare background.Demonstrated skill in data gathering, interpretation & data presentation.Familiarity with databases and comfortable generating reports

  • Strong 837 experience required

  • Background in claims, root cause analysis and / or health care data

  • Strong critical thinking skills

  • Strong analytical skills

  • Strong organizational skills including the ability to manage tasks with competing priorities

  • Familiarity with SQL along with other HIPAA transactions and code sets helpful

  • High School Diploma or GED equivalent required.Technical certification or equivalent work experience

Additional Job Information:

  • Candidate should be familiar with HIPAA transaction sets, claims processing and encounters

  • Should have ability to move multiple projects forward simultaneously and be responsible for the results even when others are directly accountable for the outcome.

  • Ability to establish effective business relationships with internal and external constituents a must

Benefit Eligibility

Benefit eligibility may vary by 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.