Aetna Hiring – Provider Data Services Analyst

Job Description:

Provides operational support and performs data maintenance and clean-up for data transactions (basic to complex). In addition, performs data transactions and maintenance associated with projects, expansions, and new product implementations. Works with other departments to ensure quality provider data to our members.

Job Responsibilities:

• Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
• Identifies, researches and conducts root cause analyses (e.g. problem providers identified by provider services team, trends from routine audits) and collaborates cross-functionally within the organization to recommend process improvements.
• Demonstrates Ability to facility meetings and make accurate records.
• Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
• Performs validation of system enhancements.
• 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.
• Demonstrated ability to handle multiple assignments.

Job Requirements:

• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
• If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
• 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.
• Performs validation of system enhancements.
• Demonstrates Ability to facility meetings and make accurate records.
• Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
• Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
• Demonstrated ability to handle multiple assignments.
• 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.

Qualification & Experience:

• Associate’s degree or equivalent work experience.

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Pittsburgh, PA, US

Application Deadline: N/A

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