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Manager, Provider Data Services

Primary Location: Detroit, Michigan
Additional Locations: MI-Detroit
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Description:
Manages a provider data services unit that may include audit staff or technical staff for the business operation.

Fundamental Components:
*Accountable for team objectives including unit scorecard measures, e.g. Quality and turn around time of Provider Data Services transactions
*Selects and builds strong functional team through a formal training, diverse assignments, communication, coaching, mentoring and performance management.
*Accountable to hire, develop and fire staff Formulates and implements strategy for the unit to meet objectives and other business initiatives
*Manages and/or participates in selected projects and organizational initiatives Cultivates and manages relationships with various external entities, e.g. vendors, large IPA/PHO's, etc
*Manages day-to-day operations of all provider data services
*Reviews audit results for accuracy and provides guidance to data services staff on items with critical business implications. *Manages audit process including error correction and rebuttal
*Partners with network management/provider relations, provider service, health delivery associates and other cross-functional areas to manage highly complex provider relationship issues of a regulatory and/or contractual nature.
*Drives change through the business operation to support competitive and changing environment (*)

Background Experience:
Proven ability to work collaboratively to resolve issues and demonstrates a broad, strategic approach to problem solving.
Demonstrated knowledge of medical cost drivers and managed care industry.
Bachelor's degree and 5 or more years of relevant experience preferred.

Additional Job Information:
Ability to effect change.Exercises sound judgment and demonstrates analytical/data-driven decision making skills.Able to assess administrative, financial and constiuent impact of provider contracts.Understands provider contracts, contracting options, and operational issues related to provider relations.

Required Skills:
Service - Demonstrating Service Discipline, Service - Providing Solutions to Constituent Needs, Service - Working Across Boundaries

Desired Skills:
General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices

Functional Skills:
Management - Management - Provider Data, Network Management - Contract negotiation, Network Management - Credentialing, Network Management - Provider connectivity, Network Management - Provider relations

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, 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. 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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