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Medical Analytics Senior Analyst

*This is a full time Work at Home opportunity in U.S. for the right candidate.

POSITION SUMMARY: As a member of the National Center of Excellence (COE) for COB Reporting and Analysis you will have a key role in identifying medical cost savings opportunities by data mining historical claims for competitor reimbursement trends.

RESPONSIBILITIES:
- Responsibilities include financial modeling of hospital and physician claims for our competitors vs. Aetna’s reimbursement to identify areas of opportunity, and advising network management on opportunities to achieve medical cost savings.
- Must have a complete understanding of contract compensation, claims processing/payment policy rules, as well as the ability to turn data into information.
- Must be able to develop and implement project plans working collaboratively with peers, across teams and provide management updates.

EDUCATION:
- Bachelor’s degree or equivalent experience.

REQUIRED SKILLS:
- Requires an understanding of the healthcare industry, healthcare data, common healthcare terminology and medical cost issues and strategies.
- Must be skilled in claims processing guidelines, ACAS benefit plans and member out of pocket components and systems (ex: ACAS, EWMP, MSW, SCM, etc.), and able to work with Microsoft Excel.
- Aetna “Data Warehouse” and other software experience (ex: Microsoft Access, SQL, DAF, Visual Basic, etc.) a plus but not required.
- Need ability to meet tight deadlines, within context of potentially changing priorities, working both independently and facilitating cross-functional solutions.
- Capable of taking project through issue identification and resolution/recommendation stages.
- General Business- Applying Reasoned Judgment, Ensuring Project Discipline, Turning Data into Information and Communicating for Impact.
- Finance/Servicing Customers Profitably.

FUNCTIONAL EXPERIENCES:
- Claims/Claim Processing – Medical or Hospital – ACAS/4-6 Years
- Claims/Claim Processing – Medical or Hospital- HMO/4-6 Years
- Network/Medical Cost Management/1-3 Years
- Network/Medical Economics/1-3 Years
- Network/Provider Relations/1-3 Years

Please note that benefit eligibility may vary by position. Go here (http://www.aetna.com/working/assets/2010_All_Benefits_Rates_at_a_Glance_OCT1.pdf) to review the benefits associated with this position.

Aetna does not permit the use of tobacco related products or drugs in the workplace.

To apply, go to https://sjobs.brassring.com/1033/ASP/TG/cim_jobdetail.asp?jobId=1608&PartnerId=25276&SiteId=5012&type=search&JobReqLang=1&recordstart=1

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Do You Have Experience In Writing Grants?

The Living Room, one of the region’s largest HIV supportive housing providers, seeks a part-time contract grant writer.

The primary responsibilities include preparation of proposals and grant applications, and professional and administrative work in researching, identifying, developing and responding to public and private grant opportunities in the areas of housing, homelessness, and HIV/AIDS.

At least five years experience writing private and government grant proposals is required, and strong preference for those with experience writing HOPWA grant proposals. Qualified candidates should also possess excellent writing and computer skills (MS Word, PowerPoint and Excel). The candidate must be highly organized, able to work effectively within external deadlines, use independent judgment and produce a quality work product within tight time constraints.

As an independent contract, the grant writer will be paid a monthly fee, set their own schedule, work from home or their own office location, and determine the best mechanisms for completing tasks assigned under the very broad supervision of the Executive Director.

Interested candidates should submit a cover letter, resume of no more than two pages, and at least three references.

Pay: 2,000.00 – 3,000.00/Monthly
Travel Required: 1% of the time
Experience Required: 5 yrs
Preferred Major: social work, business, or public administration
Preferred Degree: Masters

Contact Employer : http://bit.ly/gCxoKP