This is a fully remote position, open to applicants in Alabama, +27 more states.

📋 Description

• Negotiate individual case agreements for episodes of care prior to service delivery.

• Evaluate changes in forecasts within the Contract Negotiations sector.

• Create assessments of business impacts and modification strategies utilizing process improvement methodologies.

• Suggest strategies to address cost concerns and promote cost-saving initiatives and settlement activities.

• Build, sustain, and strengthen relationships with physicians, providers, and local network and patient management teams within Aetna markets.

• Mentor junior colleagues in techniques, processes, and responsibilities.

• Work collaboratively across internal teams to facilitate and oversee negotiations.

• Draft, implement, review, and analyze contracts.

• Conduct dispute resolution and settlement negotiations with providers.

• Ensure that contract performance meets accessibility, compliance, quality, financial, and cost objectives.

⛳️ Requirements

• Over 5 years of experience in provider contracting, claims management, or patient management.

• More than 2 years of experience in claims operations or a similar claims management setting.

• 1-2 years of experience with ACAS and HRP claims platforms, products, and benefits, along with patient management, provider relations, or claims management.

• Preferred knowledge/experience with the National Advantage Program within Aetna.

• Familiarity with Aetna systems and tools, including Smart Front End, ASD, HRP, MedCompass, and RUMBA applications (EPDB, EWMP, Rate Inquiry, and Contract Inquiry).

• A bachelor's degree is preferred or a combination of relevant professional experience and education.

• Must have the ability to work remotely from one of the designated U.S. locations.