Aetna Negotiator Analyst in Tampa, Florida
Req ID: 65818BR
Primary purpose of this position is to lead and manage the mission of obtaining the highest possible success rates and reductions on provider claims/bills, which result in savings to both the client and the insured.
Fundamental Components included but are not limited to:
Reviews inpatient, outpatient and professional claims/bills with pre-established dollar thresholds to determine negotiation strategy and potential savings. Capability to work in a production environment reviewing and negotiating 25-40 incoming claims/bills per day, on a daily basis. Utilizes manager and experienced negotiators to develop dialogue, persuasive delivery, and approach to ensure successful negotiations. Organizes and prioritizes incoming claims/bills to ensure client criteria are maintained (example: turnaround time) and established internal goals are met. Works with all departments to obtain information such as plan benefits and insured liability, to assist in the negotiation process. Handles phone and written inquiries from providers related to pre and post negotiations. Investigates and resolves issues surrounding pre and post negotiated claims/bills. Reviews provider and claim history to assist in determining appropriate percentage reduction for negotiation. Contacts provider via phone and fax as set forth under the established guidelines for claims/bills negotiations. Acquires a working knowledge of all lines of business including but not limited to Medical and Workers' Compensation. Strives to develop and maintain provider relationships. Documents system with information pertinent to claim/bill and provider. Reviews claims/bills to initiate Long Term Agreements and Master Contracts. Maintains and utilizes all resource material and systems to effectively manage job responsibilities. Independently reviews and determines resolution for claim/bill issues and concerns.
Qualifications Requirements and Preferences:
Experience in a production environment.Customer service experience. Licensure as required by state.
Information Technology - Certified Professional Coder (CPC)
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Claim
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.