Aetna Network Relations Consultant in Parsippany, New Jersey

Req ID: 56657BR

POSITION SUMMARY

Qualified candidates will be near Parsippany, NJ

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.

Fundamental Components:

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.

BACKGROUND/EXPERIENCE desired:

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.

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Network Management/Contract negotiation/4-6 Years

Functional - Network Management/Provider data services/4-6 Years

Functional - Network Management/Provider relations/4-6 Years

ADDITIONAL JOB INFORMATION

Aetna was recognized with a Military Friendly Employer Award, earning Silver status for 2017. Victory Media has been recognizing military friendly employers and schools with its annual lists since 2003. Aetna was recognized with a 2016 Top Ten Vet Friendly Employer award for virtual recruiting. As part of the VetFriendly Jobs Initiative, 71,000 veterans voted for the most veteran-friendly companies in the Veteran Recruiting Virtual Career Fairs in 2016. Aetna has been recognized by Victory Media with a 2017 Military Friendly Spouse Employer award. The annual award recognizes those companies that hire spouses of active-duty service members and promote workforce development policies and programs. CivilianJobs.com named Aetna to its 2016 list of winners of the Most Valuable Employers for Military recognition. The list is designed to help job seekers with military experience identify top employers for civilian careers. Aetnas summer internship program was ranked No. 30 out of 50 companies by VAULT 2016 Top 50 Internships. Aetna was the only health care company recognized on the list. The Human Rights Campaign Foundation named Aetna to its 2016 Best Places to Work list for lesbian, gay, bisexual and transgender (LGBT) employees. The list includes all companies that achieved a perfect score on the 2016 Corporate Equality Index. Aetna was selected as Best of the Best 2016 by U.S. Veterans Magazine. In 2015, Aetna was named to Training magazines Training Top 125, ranking #60 among the winning organizations recognized for excellence in employee development. Aetna was also named to the list in 2014, ranking # 37. Aetna has been included in the Top 125 list eight times since 2007. Aetna received a 2015 Best Employer Healthy Lifestyles Platinum Award from the National Business Group on Health.

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.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care

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.