KS MCD Provider Data Services Administrator
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 operational support and performs data maintenance for data transactions (basic to complex). In addition, performs data transactions and maintenance associated with projects, expansions.
Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
Works collaboratively with internal/external constituents to implement complex contractual arrangements.
May provide technical and/or functional leadership within unit (i.e., team lead).
Performs validation of system enhancements.
Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, trends from routine PDS audits) and collaborates cross-functionally within the organization to recommend process improvements.
Directly contacts providers and/or outside vendors to clarify data quality issues when needed.
Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
Deep dive of Complex Claim issues.
3-5 years Provider Data Services experience/background is required.
Demonstrated ability to handle multiple assignments.
Demonstrated proficiency with personal computer, mouse, keyboard and MS Office suite applications (e.g., Outlook, Word, Excel, etc.) is required.
Education and Certification Requirements:
Associate's degree or equivalent work experience.
A Bachelors degree is strongly preferred.
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User
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.