Network Relations Consultant (Provider Relations) (59597BR)Primary Location: Norfolk, Virginia
Additional Locations: VA-Norfolk Apply
Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
Monitors service capabilities and collaborates cross-functionally to ensure that the needs of constituents are met and that escalated issues related, but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved.
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 as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures.
Meets with key providers periodically to ensure service levels are meeting expectations.
Manages the development of agenda, validates materials, and facilitates external provider meetings. May collaborate cross-functionally on the implementation of large provider systems, to manage cost drivers and execute specific cost initiatives to support business objectives and to identify trends and enlist assistance in problem resolution.
Conducts standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment.
May provide guidance and training to less experienced team members. Background Experience:
3+ years' experience in business segment environment servicing providers with exposure to benefits and/or contract interpretation
3-5 years' managed care claims experience (Professional / Facility / Ancillary / Behavioral Health / Home & Community Based Service)
3-5 years' experience with business segment specific policy, benefits, plan design and language
Strong verbal and written communication, interpersonal, problem resolution and critical thinking skills
Strong presentation and training skills
Working knowledge of business segment specific codes, products, and terminology
Bachelor's Degree or equivalent combination of education and experience
Additional Job Information: Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Required Skills: Service - Demonstrating Service Discipline, Service - Providing Solutions to Constituent Needs, General Business - Managing Sales Relationships Desired Skills: General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions, Leadership - Collaborating for Results, Service - Providing Solutions to Constituent Needs Functional Skills: Claim - Claims Administration - individual billing, Claim - Policies & procedures, Management - Management - Claims Technology Experience: Aetna Application - Accounts Payable Claims, Aetna Application - Admin Support Network Potential Telework Position: Yes Percent of Travel Required: 25 - 50% 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.
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