Skip to main content

Director, Provider Data Services

Primary Location: Harrisburg, PA
Additional Locations: CT-Hartford, FL-Tampa, IL-Chicago, NJ - Montvale, PA-Harrisburg, PA-Philadelphia
Oversees a department with multiple provider data services units. Accountable for the overall delivery of provider data services including production, quality audit, reporting and process improvement for the business operation. Responsibilities include oversight for vendor resources supporting unit.

Fundamental Components:
Oversees operational management of all provider data services functions. Manages units from 30-150Accountable for department initiatives, budget, financial results and objectivesBuilds and develops strong functional operation management team through formal training, diverse assignments, coaching, communication, mentoring and performance management. Accountable to hire, develop and fire staffCultivates and manages relationships with various external entities, e.g. vendors, large IPA/PHO's, etc Ensures all PDS policies and procedures are executed consistently across business operationDirects audit procedures used for maintaining accurate provider records essential for correct reimbursement, contractual compliance, and network directory listing purposes Creates process improvement strategy to address developing internal trends e.g. changes in others' roles, error trends and external constituent needs, e.g. provider requirements for dataDrives change through the organization to support competitive and changing environment (*)

Background Experience:
Demonstrated knowledge of medical cost drivers and managed care industry. Bachelor's degree and 7 or more years of relevant experience preferred.

Additional Job Information:
Proven ability to work collaboratively at all levels.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:
Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Leadership - Creating Accountability

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Driving Change

Potential Telework Position:

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.


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, a CVS Health Company, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna, a CVS Health Company.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna, a CVS Health Company.