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Provider Data Services Consultant

Primary Location: Overland Park, KS
Additional Locations: KS-Overland Park
Provides support for provider data transactions associated with projects, expansions, and new product implementations. Resolves high volume/high impact systemic problems through proactive and reactive mechanisms (e.g. automation, route audit programs, data reporting, root cause analysis).

Fundamental Components:
Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, rework and audit trends) and recommends process improvements. Establishes, maintains and aligns complex contracted provider demographic data and negotiated reimbursement arrangements across provider systems. Creates and manages action plans for assigned projects relative to data quality and/or workflow improvements. Ensures that all impacted constituents are considered and appropriately addressed in action plans. Provides technical and/or functional leadership within unit (i.e., team lead). Performs validation of system enhancements. Extract information from provider systems to meet business reporting needs (i.e., DAF reports, fee schedule reports, Service Center Log.

Background Experience:
5+ Years of experience and knowledge of Provider Data Services systems and other end user applications.1-2 years of project management experience. Bachelor's degree or equivalent and 3+ years of relevant experience preferred.

Additional Job Information:
Experience with Provider Data Management, Complex Claims Resolution, Excellent Communication Skills

Required Skills:
Finance - Delivering Profit and Performance, General Business - Demonstrating Business and Industry Acumen, Leadership - Collaborating for Results

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Consulting for Solutions, General Business - Ensuring Project Discipline

Functional Skills:
Claim - Claim processing - Medical or Hospital- HMO, Communication - Communication Development - Executive level presentations, Information Management - Analyzes all types of capitated and fee-for-service provider contracts, performs variance analysis, Information Management - Business information analysis, Management - Management - Provider Data

Technology Experience:
Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft SharePoint, Desktop Tool - TE Microsoft Excel, Network - Provider data management

Potential Telework Position:

Percent of Travel Required:
10 - 25%

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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