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Medical Economics Consultant
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Job Detail .
Job Title: Medical Economics Consultant .
Job Group: Health Care .
Requisition #: 22365 .
Location: Middletown, CT .
Secondary Location: Hartford, CT
Middletown, CT .
Travel: 0 - 10% .
FLSA Status: Exempt .
Full/Part Time: Full Time .
Supervisory: No .
Compensation .
Pay Opportunity: $52,470.00 - $70,000.00 .
Bonus Potential: Variable % .
Requirements .
ABOUT OUR COMPANY
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.
JOB MISSION SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.
RESPONSIBILITIES:
- Work collaboratively with Market, Network and Health Care Delivery staff to complete financial analyses of Aetna Market Fee Schedule rates comparing them to state mandated workers comp fee schedules as well as industry UCR provider reimbursement rates.
- Requires the interpretation of complex provider contracts (hospital and nonfacility); utilization of multiple systems to obtain claim information; interpretation and application of contractual guidelines; analysis and reconciliation of data; reporting financial impact.
- Process adhoc contractual data report requests.
- Ensure data quality, consistency and auditing of all reports.
- Make recommendations to address business issues.
- Synthesize data from multiple sources.
- Evaluate available software applications and recommend enhancements to deliver contract analyses more efficiently.
- Lead, manage and coordinate medical economics services with HCD (Health Care Delivery) counterparts as well as other Medical Economics personnel within Aetna Workers Compensation Access.
-Develop provider compensation and fee schedules and provide consultative support to network managers with legitimacy testing of rate proposals.
-Works cross-functionally within the region and supports achievement of regional operating plan targets.
REQUIRED SKILLS:
- RequireS a Degree in Finance, Accounting or Mathematics.
- Five years of HMO/PPO insurance experience a must.
- Advanced skills in Excel, MS-Access and Web-based query tools are required.
- MCM Developer status a plus.
- The successful candidate will possess a willingness to learn new applications.
- Background must include an understanding of medical terminology and health care concepts.
- Effective project management skills (adaptable, analytical, technically proficient, detail oriented, well organized, customer service focused, team player) required along with the ability to manage multiple projects.
- Must be able to communicate effectively (verbally and in writing) with both internal and external customers.
- Demonstrate initiative, innovation and leadership in achieving results.
ADDITIONAL INFORMATION:
- This position has the potential to be a part time work from home.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position. .
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Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.
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Applicant Category: Professional
Requisition Code: Work at home
Two Initials of Recruiter: bw
System Date: 01/21/2008
System Time: 13:33:20
Document Name(40): Medical Economics Consultant
Source: JobCentral - USA
SearchTerms: "work at home" "work from home"
URL(80): http://viewjob.jobcentral.com/ljh.asp?url=https%3A//aetna.recruitmax.com/ENG/can
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