Job Description

Requisition ID: 885809 
Store # : 110342 EM Provider Ops - OH CSC 
Position: Full-Time
Total Rewards:  Benefits/Incentive Information

At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use.

 Our mission is to help people see life to the fullest—and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.

GENERAL FUNCTION

Serve as an Administrator on the Business Configuration team, responsible for provider agreement, fee schedule and network set up for EyeMed’s clients. Provide subject matter expertise for agreement, fee schedule and network set. Partner with EyeMed cross functional teams to ensure efficiency and accuracy of configuration requests.

MAJOR DUTIES AND RESPONSIBILITIES

• Set up new Network and Agreement configurations into the Facets system.
• Perform audits on all new and maintenance of agreement, network requests, fee schedules, as well as validating manual and automation processes for accuracy.
• Ensure agreement configuration accuracy that may impact provider payment and member responsibility.
• Follow the established corporate and industry audit controls when fulfilling setup and maintenance requests.
• Validate agreement and network configuration utilizing claims testing, SQL queries and Excel to ensure the configuration properly adjudicates during claims processing, for member benefit, reimbursements and provider pay amounts.
• Perform and resolve network and agreement configuration questions/issues sent to the Business Configuration team without guidance.
• Maintain relationships with Account Managers and Provider teams in order to develop a cohesive cross functional, results driven working environment.
• Self-manage completion of work inventory within established quality and turnaround time guidelines.
• Writing simple SQL queries in addition to running predesignated SQL queries to research, audit, and perform issue resolution of requests.
• Coordinate and participate in cross-functional team activities for issue resolution.
• Recommend process and system enhancements to drive improvements.
• Support the management team with on-going training activities, projects, resolving issues, and serving as a subject matter expert for all Configuration requests.

BASIC QUALIFICATIONS

• Associate degree or equivalent experience
• 5+ years of experience working within a core claims administration system.
• Good analytical and problem-solving skills
• 2+ years’ experience writing basic SQL queries and exporting data from database tables.
• Good communication and interpersonal skills
• Ability to work independently or as a part of a team.
• Ability to manage multiple complex assignments at once.

PREFERRED QUALIFICATIONS

• 3+ years’ experience in Operations in the Healthcare industry
• Experience understanding claim adjudication for member and provider reimbursements.
• Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration
• Knowledge of Medicare and Medicaid programs
• SQL and Database experience

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.

Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process.  To request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com. 

We are an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law. 

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