Provider Data Consultant - 60546BRPrimary Location: St Louis, MO
Additional Locations: IL-Champaign, MO-St Louis Apply
- Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, rework and audit trends) and recommends process improvements.
- Establishes, maintains and aligns complex contracted provider demographic data and negotiated reimbursement arrangements across provider systems.
- Creates and manages action plans for assigned projects relative to data quality and/or workflow improvements.
- Ensures that all impacted constituents are considered and appropriately addressed in action plans.
- Provides technical and/or functional leadership within unit (i.e., team lead).
- Performs validation of system enhancements. Extract information from provider systems to meet business reporting needs (i.e., DAF reports, fee schedule reports, Service Center Log.
- 5+ years of experience and knowledge of Provider Data Services systems and other end user applications.
- 1-2 years provider credentialing and data management experience
- Bachelor's degree or equivalent and 3+ years of relevant experience preferred.
- 1-2 years of project management experience helpful
Large project reviews included but not limited to reconciliation of network ids and directory flags. Processing newly credentialed providers by linking with executed contracts and submitting for load into the system.
We receive reports from different areas on the company and are required to validate the information.Required Skills: General Business - Communicating for Impact, General Business - Maximizing Work Practices, Service - Handling Service Challenges Desired Skills: General Business - Turning Data into Information, Leadership - Collaborating for Results, Service - Working Across Boundaries Technology Experience: Desktop Tool - Microsoft Word, 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.
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