Aetna Network Relations Consultant in Parsippany, New Jersey
Req ID: 48857BR
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, plan design, contract language, service, claims or compensation issues, and provider education needs.
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.
3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation.
Working knowledge of business segment specific codes, products, and terminology.
3-5 years' experience with business segment specific policy, benefits, plan design and language.
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Network Management/Provider relations/1-3 Years
Functional - Network Management/Provider connectivity/1-3 Years
ADDITIONAL JOB INFORMATION
You want to work where you can learn, grow and test yourself. And, of course, you want decent, competitive pay and benefits. Youve come to the right place. We offer more than 100 types of jobs, most with career tracks. Our salaries and benefits are market-competitive, with bonuses for high achievers. And our benefits come with lots of choices. All are aimed at helping you achieve health and financial well-being. Our employees health and financial well-being are important to us. As of April 2015, we increased our U.S. minimum base wage to $16 per hour, for both hourly and salaried employees. And effective in 2016, eligible Aetna employees can qualify for an enhanced medical benefits program that could save some families thousands of dollars.
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: Health Care