Aetna Hiring – Provider Data Services Consultant

Job Description:

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

Job Responsibilities:

• Analyzes and develops Dental Network Performance Guarantees including Recruitment, Provider Turnover, Access, and discount Guarantees.
• Ensures all provider information is analyzed using both internal and external sources.
• Maintains all Network Performance Guarantees in flight and accurately tracks, reports results to management and provides high level summary analysis on risks and mitigation plans.
• Provides support for dental network provider data analysis associated with projects, expansions, and new product implementations.
• Resolves high volume/high impact systemic problems through proactive and reactive mechanisms (e.g. automation, route audit programs, data reporting, root cause analysis).
• Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, rework and audit trends) and recommends process improvements.
• Ensures that all impacted constituents are considered and appropriately addressed in action plans. Provides technical and/or functional leadership within unit (i.e., team lead).
• Performs validation of system CRM enhancements. Extract information from provider systems to meet business reporting needs (i.e., reports, fee schedule reports, Service Center Log.

Job Requirements:

• Microsoft Office expertise.
• Associate degree or higher required
• College degree; MSU/MEU experience
• Written & virtual presentation skills.
• Superb analytical skills & critical thinking.
• Strong communication skills.

Job Details:

Company: Aetna

Vacancy Type: Full Time

Job Location: Visalia, CA, US

Application Deadline: N/A

Apply Here

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