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Credentialing Senior Analyst

Primary Location: Columbus, OH
Additional Locations: OH-Columbus
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Description:
  • Unit subject matter expert liaison to staff and customers. Identifies and resolves issues.


Fundamental Components:
  • Maintains highest performance of Credentialing Analyst functions.
  • Provides education and training to providers/producers and/or internal customers on credentialing policy and procedures.
  • Works collaboratively with network staff (local and regional) in issue/problem identification and resolution.
  • Conducts ongoing process audit to evaluate compliance with standards and outcomes (e.g. quality, accuracy, timeliness).
  • Audits timeliness and maintains resource material and/or library of available resources such as updated disks, paper references, internet, state license sources, etc.
  • Provides coaching/mentoring to peers and co-workers.
  • Assists with training to staff members.
  • May provide functional leadership within unit (i.e. team lead or supervision).
  • Creates and manages action plans for assigned projects relative to special network initiatives, workflow or quality improvements.
  • Coordinates receipt of provider/producer data with outside vendors and other entities.
  • Assists and maintains collections of data, tracking and reporting.
  • Assesses business benefit and cost of existing technology-based service or product for competitive advantage.
  • Monitors exception processes and outcomes, and recommends process improvements based on trend analysis.
  • Interprets and handles highly sensitive investigative activity in preparation for CPC / ongoing sanction activity of at risk providers.


Background Experience:
  • College degree or equivalent work experience preferred.


Additional Job Information:
  • Ability to communicate complex ideas in a logical sequence appropriate for the audience.
  • Ability to determine potential for adverse business risk, including good investigation skills.
  • Possesses a basic knowledge of credentialing accrediting agencies and their standards and guidelines.
  • Proficient computer skills, including proficiency in Microsoft Word and Excel.


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

Click To Review Our Benefits (PDF)

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