Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with smaller providers ( (i.e. local, individual providers, small groups/systems) in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals and cost initiatives.
Negotiates, executes, reviews, and analyzes contracts and/or handles dispute resolution and settlement negotiations with solo, small group, or local providers. Manages contract performance in support of network quality, availability, and financial goals and strategies. Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
Collaborates cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
Responsible for identifying and making recommendations to manage cost issues and supporting cost saving initiatives and/or settlement activities.
Provides network development, maintenance, and refinement activities and strategies in support of cross-market network management unit. Assists with the design, development, management, and or implementation of strategic network configurations, including integration activities.
May optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
Strong communication, critical thinking, problem resolution and interpersonal skills.
3-5 years related experience, proven and proficient negotiating skills.
Proven working knowledge of competitor strategies, complex contracting options, value based contracting, financial/contracting arrangements and regulatory requirements.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Sales/Managing Competitive Networks/ADVANCED
Service/Demonstrating Service Discipline/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Promoting Health Information Technology/ADVANCED
Finance/Servicing Customers Profitably/ADVANCED
ADDITIONAL JOB INFORMATION
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. Click here to review the benefits associated with this 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.