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Manager Overpayment Ideation

Primary Location: Blue Bell, PA
Additional Locations: PA-Blue Bell
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Description:
As the Manager of Overpayment Ideation, you will be responsible for building a team that identifies and creates new medical cost saving opportunities that can be developed into algorithms and models to identify and prevent improper payments throughout the medical claim lifecycle. This position in part of Aetna’s Analytics and Behavior Change Organization and supports Aetna’s Payment Integrity team.


Fundamental Components:
Primary Responsibilities:
  • Oversee the ideation function that identifies medical cost savings opportunities and manage that portfolio of work to maximize value generation.
  • Participate in analytical, investigative, and other fact-finding work in support of new concept development.
  • Establish strong matrix partner relationships to define, align, and deliver payment integrity solutions in support of business partners’ goal and objectives
  • Effectively directs and motivates staff, including providing formal feedback as part of the performance management program, training and talent development and Quality Assurance.
  • Plan, organize and prioritize activities using work plans and other project management tools
  • Provide executive level program updates and manage team escalations
  • Influence key stakeholders to adopt new ideas, approaches, and/or products
  • Operate as an industry thought leader and Payment Integrity SME


Background Experience:
Required Qualifications:
  • Bachelor’s Degree
  • 5+ years’ experience in the health care industry (Medicare, Medicaid, and/or Commercial)
  • 2+ years’ experience in Payment Integrity or with billing, coding, and auditing claims
  • 2+ years in a highly collaborative and consultative role establishing credibility quickly with all levels of management across multiple functional areas
  • Advanced proficiency in Excel and PowerPoint
  • 2+ years’ experience managing teams in a matrixed environment.
  • Maintains working knowledge of CMS rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD-9/10 coding, HCPCS and DRGs)
  • Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
  • Strong project management approach with excellent critical thinking and problem-solving skills
  • Exceptional presentation, communication and negotiation skills

Preferred Qualifications:
  • Advanced degree in health care or medical field
  • 5+ years of deep exposure to Payment Integrity issue identification and solution
  • 2+ years’ experience working in a matrix and highly adaptive environment handling tight deadlines
  • Basic level proficiency with SQL
  • Knowledge of statistical methods used in the evaluation of healthcare claims data




Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate'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.

Click To Review Our Benefits (PDF)

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