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Delegated Credentialing Analyst

Primary Location: Richmond, VA
Additional Locations: VA-Richmond
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Description:
Automates and manually loads, maintains, and resolves all new and revised participating provider data roster changes (adds and terminations) for the delegated groups.

Fundamental Components:
  • Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
  • Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
  • May provide technical and functional leadership within unit (i.e., team lead, subject matter expert).
  • Directly contacts providers and/or outside vendors to clarify data quality issues.
  • Conducts and manages audits of provider information and escalates issues for resolution as appropriate.


Background Experience:
  • Demonstrated ability to handle multiple assignments.
  • Provider Data Services background (1-3 years) or Network background (1-3 years).
  • Associate's degree or equivalent work experience.


Additional Job Information:
  • Meet with credentialing teams from our delegated provider groups.
  • Obtain updated rosters.
  • Process additions and termination for the group.
  • Align the providers to the correct contracted rates.
  • Work collaboratively with the Network Consultant assigned to the group to assure provider satisfaction.


Required Skills:
General Business - Demonstrating Business and Industry Acumen, General Business - Ensuring Project Discipline, Service - Providing Solutions to Constituent Needs

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Maximizing Work Practices

Functional Skills:
Network Management - Credentialing, Network Management - Provider data services

Technology Experience:
Aetna Application - QNXT, 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.

Click To Review Our Benefits (PDF)

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