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Encounter Validation Senior Consultant

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
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Description:
This position supports the Medicaid Encounter processes including new plan implementations, system upgrades, and regulatory changes by plan. The Analyst is responsible for defining the reporting requirements based on each state specifics and working with Data Base Analysts to ensure the report requirements are met. Proactively defines, identifies, develops and implements information products to support business strategic and operational planning. Assists in the development of and participates in the presentation to existing and prospective customers and internal business areas. Creates and executes deliverables as part of a team assigned to a business.

Fundamental Components:
  • Prepare, validate, submit, load, and log 837 encounter files and 277, 824, 999, NCPDP response files in accurate and timely manner according to state and federal regulations
  • Analyzes complex data for trends, highlights in-depth interpretations and provides in-depth root cause analysis
  • Performs ongoing research, and support tasks for existing systems
  • Creates complex queries, does technical report/programming
  • Translates complex data into constructive data and information and makes recommendations
  • Illustrates complex information in a clear concise manner
  • Influences changes/enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access
  • Evaluates available software and data to deliver better business solutions
  • Influences enhancements to business processes to improve data quality availability and access
  • Manages Health Plan and State contact, participates in internal and external health industry development efforts (e.g., performance measurements)
  • Provides workgroup support on projects
  • May lead or act as a business technical expert with the planning, development and validation of master or detail test plans and strategies
  • Leads or acts as a business technical expert in the design of new applications or enhancements including integration of solutions
  • Provides Leadership/Coaching/Mentoring; may be a mentor to others
  • Directs the implementation of program specific information through education, technology, organizational methods and procedures.


Background Experience:
  • 837, 277, 999 encounter file preparation and correction experience
  • Extensive experience with databases as well interpretation and manipulation of related data
  • Strong organizational skills. Knowledge of all types of managed care products
  • Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook) and Internet Explorer.


Additional Job Information:
Fast paced, technical and highly regulated area.

Required Skills:
General Business - Communicating for Impact, General Business - Turning Data into Information, Technology - Selecting and Applying Technology Solutions

Desired Skills:
General Business - Consulting for Solutions, General Business - Maximizing Work Practices, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance

Functional Skills:
Claim - Reporting & special services, Information Management - Data acquisition, data management, programming and documentation, Information Management - Query and Database Access Tools, Information Technology - Research

Technology Experience:
Aetna Application - Aetna Encounter Processing System, Database - SQL Server, EDI - EDI

Potential Telework Position:
No

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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