Aetna Senior Analyst in Phoenix, Arizona

Req ID: 55131BR

POSITION SUMMARY

  • Candidate should be familiar with 837 EDI/ANSI X12/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

Fundamental Components:

  • 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

  • Escalates issues appropriately

  • 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

BACKGROUND/EXPERIENCE desired:

  • 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

EDUCATION

The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Claims/Reporting & special services/1-3 Years

Functional - Administration / Operations/Data Entry/1-3 Years

Functional - Actuarial//

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/QNXT/1-3 Years/Power User

Technical - EDI/EDI/1-3 Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/FOUNDATION

General Business/Maximizing Work Practices/ADVANCED

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

General Business/Communicating for Impact/ADVANCED

General Business/Demonstrating Business and Industry Acumen/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

ADDITIONAL JOB INFORMATION

Opportunity for the right candidate to learn technical tasks in fast paced and highly regulated area.

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.