Oct 17, 2019

Provider Data Services Consultant

  • Professional Diversity Network
  • Detroit, MI, USA
Full-Time Other

Job Description


Description: Provides support for provider data transactions associated with projects, expansions, and new product implementations. Resolves high volume/high impact systemic problems through proactive and reactive mechanisms (e.g. automation, route audit programs, data reporting, root cause analysis).


Fundamental Components:
  • 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.
Background Experience:
  • 3+ Years of experience and knowledge of Provider Data Services systems and other end user applications.
  • 1-2 years of project management experience.
  • Bachelor's degree or equivalent and 3+ years of relevant experience preferred.
Additional Job Information: The ideal candidate will work to help ensure the accuracy of Aetna Better Health of Michigan provider data included in its online/paper directories and engage in roster maintenance strategies to drive excellence. Required Skills: General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Ensuring Project Discipline Desired Skills: General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices, General Business - Turning Data into Information Functional Skills: Claim - Claim processing - Medical or Hospital- HMO, Network Management - Credentialing, Network Management - Provider connectivity, Network Management - Provider data services, Network Management - Provider relations Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, 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.





Apply Now