Aetna Network Relations Consultant 46222BR in Bedford, New Hampshire
Req ID: 46222BR
Develops strong relationships with network providers and internal business partners leading to the achievement of provider satisfaction, medical cost targets, network growth and/or efficiency targets.
Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with smaller providers ( (i.e. local, individual providers, small groups/systems) in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives.
Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers. Manages contract performance in support of network quality, availability, and financial goals and strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Strong communication, critical thinking, problem resolution and interpersonal skills.
Proficient computer skills; comfortable using and mastering technology, EXCEL and software programs
Knowledge of basic negotiating skills.
Working knowledge of standard provider contracts, terms and language desired.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Technical - Desktop Tools/Microsoft Word//
Technical - Desktop Tools/TE Microsoft Excel//
General Business/Demonstrating Business and Industry Acumen/FOUNDATION
Service/Improving constituent-focused Processes/FOUNDATION
Considered only for locations in a specific region, state, or city; training period in the office may be required
ADDITIONAL JOB INFORMATION
This is an excellent entry level role for an individual that wants to learn the ins and outs of Network and Provider Services; Requires an analytical mind and attention to detail; Excellent Working knowledge of provider business operations and overall business processes. Insurance or health insurance billing background helpful.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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.
Job Function: Health Care