KS MCD Provider Data Services Analyst
Overland Park, KS
Maintains the Provider Data (demographic and contractual) for all network and non-network providers. Ensures all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (i.e., directory listings). Maintains standards for database integrity, corrective actions and database alignment.
Provides support for baseline provider data transactions that cannot be administered automatically through the provider database due to system limitations and/or data integrity issues.
Performs baseline demographic transaction updates in provider system applications in support of claim adjudication and Provider directory
Performs intake triage and responds to network inquiries, escalates when necessary.
Provides on-going department support in research and analysis essential to resolving concerns/issues raised by providers and other internal/external customers.
Sends requests to individual providers and/or delegated groups to verify information on file and follows up as needed to ensure information is received.
Conducts audits of provider information and escalates issues for resolution as appropriate.
SCR creation/submission of expected configuration changes based upon SME output
PCR creation/submission of expected configuration changes based upon SME output
PCR quality review (post configuration)
Demonstrated proficiency with personal computer, mouse, keyboard and MS Office suite applications (e.g., Outlook, Word, Excel, etc.) is required.
Previous industry experience or claims processing preferred.
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/Power User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
General Business/Maximizing Work Practices/ADVANCED
General Business/Communicating for Impact/ADVANCED
Leadership/Collaborating for Results/FOUNDATION
General Business/Turning Data into Information/FOUNDATION
Service/Working Across Boundaries/FOUNDATION
ADDITIONAL JOB INFORMATION
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.
Aetna takes our candidates'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.