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Systems Analyst - QNXT

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
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Description:
Accountable for and manages the development, implementation and ongoing maintenance of project(s) with relatively small and/or less complex scope and deliverables. Project scope typically impacts one of the following: process, system, function, and/or product. Length of project may run one year or less in duration.

Knowledge of claim system, QNXT, and able to support modifications to the build to support Medicaid and Medicare Advantage business in Arizona.

Fundamental Components:
  • Provides input on business plan to achieve business goals.
  • Proactively leads assigned project by creating project timeline, identifying key milestones and additional resources needed to successfully complete the work.
  • Assists with the management of internal relationships, processes and performance drives (in some cases relationships may be external).
  • Negotiates to obtain additional resources (may be cross functional/segment).
  • Responsible for the financial implications of the project.
  • Identifies issues that may stall project and works with manager to address them.
  • Tracks progress and communicates project status on a regular basis to all impacted parties.
  • Communicates changes and updates to ensure all impacted parties (up stream/down stream) are informed of next steps for completion.
  • Acts as an advocate for change, may require influencing others to see the value in project.
  • Group facilitation/presentation influencing various internal (these may be cross-functional/segment) may also include external parties.
  • May coach or mentor others by providing work direction.
  • May identify gaps and recommend enhancements related to new and/or existing products, services and workflows based on broad view of the organization.
  • Develops recommendations based on complex data and root cause analysis.
  • May serve as a Subject Matter Expert for contract, benefit configuration in QNXT.


Background Experience:
  • Proven track record meeting project dates.

  • 3-5 years related work experience.

  • Claim - Policies & procedures

  • Communication - Provider communications

  • General Management - Data analysis & interpretation

  • General Management - Process & quality improvement

  • General Management - Data tools: building & utilization

  • Information Management - Business information analysis

  • Information Management - Researches overpayments and prepares projects for recovery

  • Information Management - Supports the maintenance of scoreable action items documents by providing ad hoc analysis

  • Project Management - Issue identification and analysis

  • Aetna Application - Alchemy Search

  • Aetna Application - Claim Reporting System

  • Aetna Application - Credentialing and Recredentialing Data Sys

  • Aetna Application - EDI Claim Lookup

  • Aetna Application - MBU Encounter Management System

  • Aetna Application - PCR Form

  • Aetna Application - Plan Reference Table

  • Aetna Application - Provider Contracts

  • Aetna Application - Provider Directory Reporting

  • Aetna Application - QNXT

  • Aetna Application - Repricer

  • Database - Microsoft SQL Server



Additional Job Information:
  • Ability to communicate effectively with management.
  • Ability to work collaboratively within work teams.
  • Excellent verbal and written communication skills.
  • Strong organization skills.


Clinical Licensure:
N/A

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.

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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