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Network Operations Lead

Primary Location: St Louis, Missouri
Additional Locations: CO-Denver, IA-Urbandale, IL-Champaign, KS-Overland Park, KS-Wichita, MO-St Louis, NE-Omaha
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Description:

Manages all aspects of networkoperations in support of Network/Cost Leader and Market Presidents and acts ascoordination point across all business partners; key internal role responsiblefor maintaining network operations, supporting various activities associateswith network filings, network compliance and dispute re solution/litigation



Fundamental Components:



Partner across the organization
to support network development, maintenance, refinement activities, regulatory
filings, migration and rate activities to ensure consistent and efficient
operations across market



Specific focus and priorities of role will be at the
discretion of the Market President and Network/Cost Leader as needed across the
multiple Heartland markets



Manages and maintains accuracy of provider data in
collaboration with Provider Data Operations organization



Compiles/prepares case files (e.g., analytics,
paperwork, etc.) and manages independent provider dispute resolution process
(e.g., “surprise bill”); supports Network/Cost Leader and Market President, in
partnership with Legal, in managing litigation (e.g., panels, hearings,
depositions, arbitration, court appearances)



Responsible for understanding policy changes and
assessing how changes impact network strategy, as well as state and Medicare
regulatory compliance; prepares and submits required state and CMS filings



Partners closely with National Network functions
including Provider Operations and Data Services



ABX initiatives/tools for
process improvement and end to end focus





Background Experience:
8 – 10 years related experience in health operations, network relations and development, command of financials and pricing strategies, and sales interface. Experience building and maintaining relationships with provider systems. A successful track record managing and negotiating major provider contracts. In depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers/providers. Knowledge and experience with value based contracting and accountable care models In-depth knowledge of managed care business, regulatory /legal requirements. Solid leadership skills, including staff development and talent management Bachelors degree or equivalent work experience. MBA/Masters degree preferred

Additional Job Information:
Job description may also be used for other products besides Commercial medical: e.g., dental, worker’s comp, behavioral health, Medicare, Medicaid, etc.; systems and tools mentioned in the description would align and reflect appropriate product, segment.

Required Skills:
General Business - Demonstrating Business and Industry Acumen, Leadership - Creating a World Class Workforce

Desired Skills:
Leadership - Driving Strategic and Organizational Agility

Functional Skills:
Network Management - Contract negotiation, Network Management - Provider data services

Technology Experience:
Desktop Tool - Microsoft Outlook

Potential Telework Position:
Yes

Percent of Travel Required:
10 - 25%

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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