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Senior Quality Consultant (QNXT, Configuration experience)

Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix
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Description:

Provides consultation on the quality of QNXT configurations for contracts, provider information, and health plans. Researches, manipulates and prepares complex data to document program activities and reports on its results. Provides oversight to data quality and provides feedback to various
areas in order to improve service delivery and enhancement to design efforts. Develops a consultative relationship with internal customers.





Fundamental Components:
Perform related duties as assigned by CSRA management, including but not limited to:

  • Completes all required quality activities required for the maintenance of existing health plans and implementation of new health plans.
  • Assists with performing focused audits when requested.
  • Identifies process improvements for the CSS department for increasing work quality and reducing Remedy ticket TAT.
  • Represents CSS as the quality process expert for various internal and external meetings as required.
  • Trains new staff as required to work in the CSS QC group.
  • Maintains a 100% ticket target volume for SCR/IIF/Project QC assignment activities.
  • Provides Leadership/Coaching/Mentoring; to others on the CSS team.
  • Directs the implementation of program specific information through education, technology, organizational methods and procedures
  • Influences enhancements to business processes and system infrastructure to improve data quality availability and access.
  • Conducts quality analysis on completed tickets and provides recommended configuration revisions and clarifications for solution documentation.
  • Analyzes complex data for trends, highlights in-depth interpretations and provides in-depth root cause analysis.
  • Translates complex data into constructive data and information and makes recommendations.
  • Illustrates complex information in a clear concise manner through communication and job aids
  • Provides work group support on projects.
  • Influences changes/enhancements to business processes, policies, and system infrastructure to improve information quality, availability and access.





Background Experience:



  • 3-5 years of data interpretation and quality analysis experience.
  • 1-5 years of QNXT configuration experience.
  • Extensive experience with databases as well as interpretation and manipulation of related data.
  • Healthcare background-preferred
  • Excellent verbal and written communication skills.
  • Excellent attention to detail and analytical skills.






Additional Job Information:
This is a fast paced quality department supporting Configuration Solutions and Reimbursement Management. We are looking for a business professional who has strong attention to detail, clear communication, organizational, and analytical skills with experience evaluating quality or QNXT configuration experience. Claims processing experience is also a plus.




Required Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Collaborating for Results

Desired Skills:
Leadership - Creating a World Class Workforce

Functional Skills:
Communication - Communication Quality Control, General Management - Data analysis & interpretation

Technology Experience:
Aetna Application - BMC Remedy 7.5 Suite, Aetna Application - QNXT

Potential Telework Position:
Yes

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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