KS MCD Provider Data Services Consultant


Overland Park, KS
United States

Job Description
POSITION SUMMARY
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, database alignment, and manages communication processes with other departments regarding database improvements.

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.
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).
Extract information from provider systems to meet business reporting needs (i.e., DAF reports, fee schedule reports, Service Center Log.
SCR (System Change Request) creation/submission of expected configuration changes based upon SME output.
PCR (Provider Change Request) creation/submission of expected configuration changes based upon SME output.
PCR quality review (post configuration).


BACKGROUND/EXPERIENCE desired:
Background/Experience Desired:
Minimum of 5 years of experience and knowledge of Provider Data Services systems and other end user applications is required.
1-2 years of project management experience is preferred.
Demonstrated proficiency with personal computer, mouse, keyboard and MS Office suite applications (e.g., Outlook, Word, Excel, etc.) is required.

Education and Certification Requirements:
Bachelor's degree or equivalent work experience is required.


EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

TECHNOLOGY EXPERIENCES
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 SharePoint/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User


REQUIRED SKILLS
Technology/Selecting and Applying Technology Solutions/ADVANCED
Technology/Developing Software Solutions/FOUNDATION
Service/Working Across Boundaries/FOUNDATION


DESIRED SKILLS
General Business/Maximizing Work Practices/ADVANCED
General Business/Applying Reasoned Judgment/MASTERY
General Business/Turning Data into Information/MASTERY


ADDITIONAL JOB INFORMATION

Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Kansas is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of KanCare members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Kansas, and we will support you all the way.

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.




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.