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.
Internally supports and contributes to positive provider relationships by handling routine provider service inquiries and problems regarding policies and procedures, benefits, credentialing process or status, and claims or compensation process or status. Supports the maintenance of contract or demographic data.
68314 Fundamental Components:
•Triages routine provider issues and internal inquiries regarding policies and procedures, credentialing or claims status, orientation activities, and database or portal information or usage. Escalates issues as appropriate.
•Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination.
•Performs credentialing support activities as needed.
•Educates providers on portals, protocols, policies, procedures, and services to enhance the overall provider experience.
•May assist with or perform standard provider recruitment or contracting or recontracting functions and discussions.
•Mails and tracks standard contracts.
•Sends executed contract and or signature page to new provider including welcome
•Scans standard/non-standard signature page and any related documents.
•Supports the coordination of Provider materials.
•Supports the coordination of Provider forums.
•As assigned and with direction, conducts Provider Directory audit.
•Supports the coordination of returned provider mail.
•Manages incoming web portal requests from providers.
•Coordinates interactions with internal staff as needed.
•Interprets contractual requirements including federal and state regulations and NCQA.
•Promotes and educate providers on cultural competency. Background Experience:
Additional Job Information:
•Associate's degree OR equivalent work experience.
•1-3 years' related customer service experience preferably with exposure to benefits interpretation.
•Customer service experience within a health plan or managed care industry.
•Prior experience in a similar role within the Government sector (Medicaid or Medicare) desired.
•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.
•Strong verbal and written communication and interpersonal skills.
•Exposure to business segment specific policy, benefits, plan and product design and language.
•Working knowledge of business segment specific codes, products, and terminology.
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. 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.