Aetna Network Relations Consultant (56395BR) in Tucson, Arizona

Req ID: 56395BR

POSITION SUMMARY

Provider Relations candidate must have the ability to develop strong relationships with network providers and internal business partners leading to high provider satisfaction scores and meet all network management goals and requirements, while maintaining all regulatory requirements. Candidate must have excellent working knowledge of overall provider business operations and have vast experience working with AHCCCS, DDD, ALTCS, Medicare Advantage-SNP, RBHA and all Provider Types.

Fundamental Components:

Candidate must have a minimum of 2 -4 years of functional experience in Provider Relations/Network Management working with all provider types including: PCPs, Specialists, Hospitals, Skilled Nursing Facilities, Ancillary, Behavioral Health, Home and Community Based Providers, and Dentists. Candidate has strong experience in contract management, compliance, reimbursement methodologies, provider data management, credentialing, healthcare accounts receivables and claims reconciliation processes. Candidate must demonstrate excellent communicate skills and be able to work with staff at all levels.

There are two positions available one is located in the Phoenix, AZ office the other position is a full time work at home but you must live within commuting distance to the Tucson, AZ office.

BACKGROUND/EXPERIENCE desired:

*Candidate must have 2-4 years of recent and functional experience in Provider Relations working with all provider types

*Strong interpersonal, written and oral communication skills required

*Minimum of 2 years experience working with government contracts including AHCCCS and CMS

*Knowledgeable in reimbursement methodologies, claims troubleshooting, provider set-up and root cause analysis

EDUCATION

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

LICENSES AND CERTIFICATIONS

Managed Care/ is desired

FUNCTIONAL EXPERIENCES

Functional - Network Management/Contract negotiation/1-3 Years

Functional - Network Management/Provider relations/1-3 Years

Functional - Network Management/Credentialing/1-3 Years

Functional - Network Management/Provider data services/1-3 Years

Functional - Network Management/Physician recruiting - medical/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

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

ADDITIONAL JOB INFORMATION

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.

#LI-MR1

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.