Aetna Project Lead in Phoenix, Arizona

Req ID: 42771BR


Accountable to assure encounter files for assigned state(s) are developed, prepared, submitted, logged, reconciled and errors corrected according to state/federal regulations. Responsible for various mapping documents, report preparation and validation, inventory management and setting team priorities while executing toward department goals and metrics.

Fundamental Components:

  • Assign tasks to team members based on inventory of internal and external rejects, issues, research and other deliverables

  • Project manage various tasks related to encounters for assigned state(s)/product(s) ranging from mapping documents, schedules and inventory management to production issue escalation

  • Work through other internal customers (i.e. Claims, CSSR, IT, Plan) to develop solution(s) for new requirements or configuration/setup that cause encounter rejects, perform root cause analysis

  • Work with external customers (i.e. state/federal regulator, software vendor, subcontracted vendors (i.e. dental, pharmacy, transportation, vision, etc.) to address requirements, rejects, issues, inventory management

  • Use health plan operations, claim processing, technical background to develop viable solution(s) to assure that complete and accurate encounter data is reported while eliminating encounter rejects and rework

  • Synthesize technical information or regulations to assure that encounter data for assigned state(s)/product(s) is compliant and error inventory is resolved

  • Lead or assist in requirements gathering/documentation, report preparation and/or validation, audit responses and request for proposal (RFP) support

  • Manage multiple competing priorities


    3-5 years of Demonstrated leadership

    3-5 years of project management experience.

    3-5 years of data interpretation and analysis experience.

    Excellent verbal and written communication skills.

    Demonstrated ability to effectively coordinate multiple projects simultaneously.

    Must have experience working with encounter files/data


    The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


    Technical - Aetna Applications/QNXT/4-6 Years/Power User

    Technical - EDI/EDI/4-6 Years/Power User

    Technical - Subject Disciplines/Business Process Management/1-3 Years/End User

    TechnicalExperience/TechnicalFocus/1-3 Years/End User

    Telework Specifications:

    Considered only for current internal teleworkers (in any area)


    Fast paced opportunity to lead various efforts to implement new plans, oversee and troubleshoot production issues for 837 encounter files, and assign work to various team members. Coordinate meetings, prepare and update project plans, prepare communications to various internal and external customers.

    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 candidate'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.

Job Function: Health Care