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Provider Network Operations Consultant

Primary Location: Richmond, Virginia
Additional Locations: VA-Richmond
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Description:
Serves as the subject matter expert in support of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals.

Fundamental Components:
  • Responsible for reviewing, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems.
  • Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.
  • Provides technical expertise for questions related to contracting and related systems and information contained. Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration and rate activities.
  • May coordinate complex contracting activities, implementation, coordinate receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.
  • Collaborates on negotiations or may handle contracting and re-contracting discussions with solo providers or small groups.
  • May conduct or assist with service activities such as provider education, technology usage, or process updates.
  • May recruit providers in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets .


Background Experience:
  • 3 years related experience.
  • Knowledge of basic negotiating skills desired.
  • Proven working knowledge of standard provider contracts, terms and language desired.
  • Strong communication, critical thinking, problem resolution and interpersonal skills.
  • Bachelor’s Degree or equivalent combination of education and experience.


Additional Job Information:
This position with work with a limited number of key health systems in Virginia to provide exceptional problem resolution. This is primarily resolving claims that the provider has indicated are not paying correctly. Candidate needs to be able to understand the contract between ABH VA and the health system, and assure it is configured correctly in the provider data base.

Required Skills:
Finance - Servicing Customers Profitably, General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Ensuring Project Discipline, Service - Working Across Boundaries

Functional Skills:
Claim - Policies & procedures, Communication - Provider communications, Network Management - Provider relations

Potential Telework Position:
No

Percent of Travel Required:
25 - 50%

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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