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Network Relations Consultant

at Aetna Inc.

Posted: 6/7/2019
Job Reference #: 64395
Keywords:

Job Description

Job Description
Acts as the primary resource for assigned, high profile providers or groups (i.e. local,
individual providers, small groups/systems) to establish, oversee, and maintain positive
relationships by assisting with or responding to complex issues regarding policies and
procedures, plan design, contract language, service, claims or compensation issues, and
provider education needs.

Req#
60516BR

Job Group
Health Care

Full or Part Time
Full Time

Supervisory Responsibilities
No

Percent of Travel Required
0 - 10%

Posting Job Title
Network Relations Consultant

Potential Telework Position
No

Additional Locations
GA-Atlanta

Primary Location (City, State)
GA-Atlanta

EEO Statement
Aetna is an Equal Opportunity, Affirmative Action Employer

Resource Group
1

Fundamental Components
• Optimizes interactions with assigned providers and internal business partners to
   establish and maintain productive, professional relationships.
• Monitors service capabilities and collaborates cross-functionally to ensure that the
  needs of constituents are met and that escalated issues related but not limited to, claims
  payment, contract interpretation or parameters, and accuracy of provider contract or
  demographic information are resolved.
• Supports or assists with operational activities that may include, but are not limited to,
  database management, and contract coordination. Performs credentialing support
  activities as needed.
• Educates providers as needed to ensure compliance with contract policies and
  parameters, plan design, compensation process, technology, policies, and procedures.
• Meets with key providers periodically to ensure service levels are meeting expectations.
  Manages the development of agenda, validates materials, and facilitates external provider meetings.
• May collaborate cross-functionally on the implementation of large provider systems, to
  manage cost drivers and execute specific cost initiatives to support business objectives
  and to identify trends and enlist assistance in problem resolution.
• Conduct standard provider recruitment, contracting, or re-contracting activities and
  assist with more complex contracting and discussions as needed by business segment.
• May provide guidance and training to less experienced team members.

Background Experience
• 3+ years' experience in business segment environment servicing providers with
   exposure to benefits and/or contract interpretation.
• Working knowledge of business segment specific codes, products, and terminology.
• 3-5 years' experience with business segment specific policy, benefits, plan design and
  language.
• Strong verbal and written communication, interpersonal, problem resolution and critical
  thinking skills.

Benefits Program
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information
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.