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Encounter Validation Analyst

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix, DE-Newark, FL-Jacksonville
Performs research and analysis of multiple data sources to meet business/clients needs. Gathers and documents business requirements into specifications for information products with management support.

Fundamental Components:
  • Candidate is responsible for the creation and submission of encounter data to State and federal entities in accordance with regulatory and contractual requirements for accuracy and timeliness
  • Resolves problems in a timely and effective manner
  • Uses designated systems to obtain information
  • Understands the impact of actions on system primarily used/maintained
  • Understands relationships of designated systems
  • Analyzes and verifies system results to ensure accuracy, accountability and financial data integrity
  • Possesses working knowledge of functions of other units in department
  • Responds to and resolves customer inquiries and complaints (internal as well as external), both verbal and written correspondence within established unit time frames
  • Analyzes and resolves system error conditions within established unit time frames
  • Participates as a member of a project team
  • Analyzes and recommends solutions to nonstandard requests and requirements from plan sponsors and areas within and outside the area
  • Processes customer new business and other transactions and records in appropriate systems
  • Uses system produced data to prepare management level reports
  • Oversight for reporting on 1-3 Medicaid plans
  • Monitor, review, research, reconcile and balance designated Aetna system activity

Background Experience:
  • Excellent verbal and written communication skills.
  • Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook) and Internet Explorer.
  • Strong organizational skills.3-5 years of data interpretation and analysis experience.
  • Basic programming skills (e.g., to run extracts).
  • Healthcare background.Demonstrated skill in data gathering, interpretation & data presentation.Familiarity with databases and comfortable generating reports
  • Strong 837 experience required
  • Background in claims, root cause analysis and / or health care data
  • Strong critical thinking skills
  • Strong analytical skills
  • Strong organizational skills including the ability to manage tasks with competing priorities
  • Familiarity with SQL along with other HIPAA transactions and code sets helpful
  • High School Diploma or GED equivalent required.Technical certification or equivalent work experience

Additional Job Information:
  • Candidate should be familiar with HIPAA transaction sets, claims processing and encounters
  • Should have ability to move multiple projects forward simultaneously and be responsible for the results even when others are directly accountable for the outcome.
  • Ability to establish effective business relationships with internal and external constituents a must

Potential Telework Position:

Percent of Travel Required:

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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