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TX STAR+PLUS Network Operations Consultant

Primary Location: Dallas, TX
Additional Locations: TX-Dallas, TX-Ennis, TX-Grand Prairie, TX-Greenville, TX-Irving, TX-McKinney, TX-Plano, TX-Terrell
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Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

Reviews, analyzes, evaluates, and validates provider contracts. Supports contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for assisting in the reviewing, building and auditing complex contracts and network data, support recruitment efforts, and collaborate on negotiations as needed.


Fundamental Components:
  • Responsible for reviewing, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems.
  • Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.
  • Provides technical expertise for questions related to contracting and related systems and information contained.
  • Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration and rate activities.
  • May coordinate complex contracting activities, implementation, coordinate receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.
  • Collaborates on negotiations or may handle contracting and re-contracting discussions with solo providers or small groups.
  • May conduct or assist with service activities such as provider education, technology usage, or process updates.
  • May recruit providers in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets.
  • Interprets contractual requirements including federal and state regulations and NCQA.
  • Participates in JOC meetings.
  • Promotes and educate providers on cultural competency.
  • Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation, and reimbursement modeling activities including credentialing.


Background Experience:
  • 3 years related experience.
  • Knowledge of basic negotiating skills desired.
  • Proven working knowledge of standard provider contracts, terms and language desired.
  • Strong communication, critical thinking, problem resolution and interpersonal skills.
  • Bachelor’s Degree or equivalent combination of education and experience.
  • Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.


Additional Job Information:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR+PLUS, STAR/CHIP, and STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

Required Skills:
Benefits Management - Interacting with Medical Professionals, Sales - Managing Competitive Networks, Sales - Negotiating Collaboratively

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Turning Data into Information

Functional Skills:
Information Management - Analyzes all types of capitated and fee-for-service provider contracts, performs variance analysis, Network Management - Contract negotiation

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft 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.

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.

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