Medicaid PDS AnalystPrimary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix Apply
- Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
- Performs intake triage and responds to network inquiries, escalates when necessary.
- Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
- Sends requests to individual providers and/or delegated groups to verify information on file and follows up as needed to ensure information is received. Conducts audits of provider information and escalates issues for resolution as appropriate.
- Demonstrated PC skills, including Microsoft Office products and internet navigation skills. Strong Excel skills a plus.
- Previous industry experience or claims processing preferred.
- High School Diploma or G.E.D.
For Medicaid, Provider Data is updated within the QNXT claims processing system. Candidates will be trained to update provider data based on PCR submissions and Claim research.Required Skills: General Business - Consulting for Solutions, Service - Demonstrating Service Discipline, Service - Working Across Boundaries Desired Skills: General Business - Maximizing Work Practices, Service - Handling Service Challenges Functional Skills: Administration / Operation - Data Entry Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - TE Microsoft Excel 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.
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