Aetna Encounter Validation Analyst in Newark, Delaware
Req ID: 67742BR
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 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.