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Provider Data Services Senior Analyst

Primary Location: Harrisburg, Pennsylvania
Additional Locations: PA-Harrisburg
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Description:
Automates and manually loads, maintains, and resolves all new and revised participating provider data transactions (basic to complex) that are contractually sensitive or strategic nature. May also load third party contracted reimbursement into applicable systems.

Fundamental Components:
  • Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
  • Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements. May provide technical and functional leadership within unit (i.e., team lead, subject matter expert).
  • Directly contacts providers and/or outside vendors to clarify data quality issues. Conducts and manages audits of provider information and escalates issues for resolution as appropriate.


Background Experience:
  • Demonstrated ability to handle multiple assignments.
  • Provider Data Services background (1-3 years) or Network background (1-3 years).
  • Associate's degree or equivalent work experience.


Additional Job Information:
Coordinating clinical coding reviews with nurses and Medical Directors for the Aetna Medicaid plans. Scrubbing pended claim reviews for the nurses and assisting with simple coding reviews.

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

Desired Skills:
General Business - Maximizing Work Practices, General Business - Turning Data into Information, Service - Handling Service Challenges

Functional Skills:
Claim - Policies & procedures, Claim - Quality management, Claim - Reporting & special services

Technology Experience:
Aetna Application - EDI Claim Lookup, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word

Potential Telework Position:
Yes

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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