Aetna Senior Business Consultant - 64564BR in Santa Ana, California
Req ID: 64564BR
Office based in Woodland Hills, CA or Santa Ana, CA
Represent Aetna to our contracted providers and focus on executing on national initiatives at local market level through identifying local market Risk Adjustment opportunities to improve accuracy and completeness of captured codes.
Manage and direct local and national vendors around provider and member outreach and engagement.
Conduct data analysis, in conjunction with national tools, to identify opportunity areas and present to key stakeholders.
Provides feedback to providers on accuracy and improvement opportunities relevant to Risk adjustment.
Develops training documents and tools; assures that internal and external stakeholders related to CMS guidelines and Risk
Adjustment best practices.
Engage with clinical team and specific clinics, medical groups, hospitals; attends JOM meetings; Supports and interact with quality engagement managers and RN program managers as needed.
Additional dock-in points needed to manage include MSO, product, sales, network, performance, MEU.
Integrates risk adjustment activities with quality initiatives where possible.
Identifies alternate data sources and facilitates capture through corporate processes
Fundamental Components included but are not limited to:
Requires minimum of a bachelor s degree in a clinical, technical or quantitative field (health Sciences, health management, nursing, actuarial science, social science, healthcare) or equivalent combination of experience and education. MBA or other relevant
Master s degree preferred, but not required.
Requires a minimum of 5+ years of healthcare industry experience.
Qualifications Requirements and Preferences:
3+ years of Medicare Advantage experience with heavy focus in Risk Adjustment areas terms and best practices.
Thorough understanding of the financial/Clinical metrics and claims/encounters.
Experience in healthcare including provider network relationship management with a focus on California and experience in a consultative role.
Experience developing training programs and provider tools required.
Ability to foster trust/relationships with internal partners and key provider groups
Additional Job Information:
Team leadership and team building skills.Analytical and planning skills.Negotiation/influencing skills.Relationship and change management skills.Organizational skills.Time management skills.Critical thinking skills.Oral and written communication skills.
Benefit eligibility may vary by position.
Job Function: Management
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.