Job Description
Job Description
Provides support for significant Exchange product and benefit initiatives. This includes all new Exchange Market product offerings that will be implemented on the NextGen Strategic platform. Successful candidates will have a mix of product and benefits knowledge and its use in claims adjudication processing.
If your goal is to combine your strong healthcare product/benefit knowledge, with a bent for analytic and technical implementation, then this is the ideal job for you.
- You will determine the best approach for driving the desired benefit outcomes in claims processing and provider payment.
- Experience with coding standards, ICD 10, CPT and HCPC codes would be beneficial.
- You will also need to evaluate the impact of CMS and state legislation on benefit plans.
- This is a unique opportunity to be on a dynamic Team that is shaping the new delivery of healthcare.
- Communicates product features and fundamental components to the organization that reflects the product and responds to the needs of various "stakeholders" (i.e., employees, customers, shareholders) while communicating the need and rationale for policies and standards
- Represents product strategy in cross functional project activities, e.g. ID card workgroup & Legislative Review Committee
- Collaborates with market segment to develop and implement plans to achieve segment product strategies
- Serves as project manager and/or participant for selected projects
- Independently manages mid-sized product enhancements
- Ensures that systems are designed, developed, implemented and maintained from a product and business/customer point of view
- Performs research and analysis on legislative, competitive and industry issues to recommend new products or product enhancements
- Participates in idea generation and project vision session for the development of new products and product enhancements
- Gathers and analyzes feedback in support of performance analysis for products and continual improvement
- May participate and/or conduct focus group sessions, broker briefings or one-on-one meetings with consultants, brokers, general agents and/or employer groups in support of sales efforts
Required Qualifications
- 3-5 years related work experience
- Bachelor's degree or equivalent experience
- In-depth understanding of the Medicare regulatory environment, and impacts to benefits and claims adjudication
- Knowledge of claim handling and associated processes such as provider contracting
- Strong analytical skills, and ability to apply concepts into actionable configuration
- Very proficient in use of Excel
- Knowledge of industry claim coding and billing standards
Preferred Qualifications
Please review required qualifications above
Education
Bachelor's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Provides support for significant Exchange product and benefit initiatives. This includes all new Exchange Market product offerings that will be implemented on the NextGen Strategic platform. Successful candidates will have a mix of product and benefits knowledge and its use in claims adjudication processing.
If your goal is to combine your strong healthcare product/benefit knowledge, with a bent for analytic and technical implementation, then this is the ideal job for you.
- You will determine the best approach for driving the desired benefit outcomes in claims processing and provider payment.
- Experience with coding standards, ICD 10, CPT and HCPC codes would be beneficial.
- You will also need to evaluate the impact of CMS and state legislation on benefit plans.
- This is a unique opportunity to be on a dynamic Team that is shaping the new delivery of healthcare.
- Communicates product features and fundamental components to the organization that reflects the product and responds to the needs of various "stakeholders" (i.e., employees, customers, shareholders) while communicating the need and rationale for policies and standards
- Represents product strategy in cross functional project activities, e.g. ID card workgroup & Legislative Review Committee
- Collaborates with market segment to develop and implement plans to achieve segment product strategies
- Serves as project manager and/or participant for selected projects
- Independently manages mid-sized product enhancements
- Ensures that systems are designed, developed, implemented and maintained from a product and business/customer point of view
- Performs research and analysis on legislative, competitive and industry issues to recommend new products or product enhancements
- Participates in idea generation and project vision session for the development of new products and product enhancements
- Gathers and analyzes feedback in support of performance analysis for products and continual improvement
- May participate and/or conduct focus group sessions, broker briefings or one-on-one meetings with consultants, brokers, general agents and/or employer groups in support of sales efforts
Required Qualifications
- 3-5 years related work experience
- Bachelor's degree or equivalent experience
- In-depth understanding of the Medicare regulatory environment, and impacts to benefits and claims adjudication
- Knowledge of claim handling and associated processes such as provider contracting
- Strong analytical skills, and ability to apply concepts into actionable configuration
- Very proficient in use of Excel
- Knowledge of industry claim coding and billing standards
Preferred Qualifications
Please review required qualifications above
Education
Bachelor's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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