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Administrator - Operations (Provider & Network set-up)Date: Jan 29, 2024Brand: EyeMed Vision CareLocation:Mason, OH, US, 45040Requisition ID: 834041Position: Full-TimeTotal Rewards: Benefits/Incentive Information (https://careers.essilorluxottica.com/content/Benefits-and-Perks/?locale=enUS)There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same. And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear. In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands. Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.GENERAL FUNCTIONServe 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 Luxottica Ethics Compliance Hotline at 1-888-887-3348 (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.Nearest Major Market: CincinnatiJob Segment: Healthcare Administration, Medicaid, Medicare, Operations Manager, Healthcare, Operations
Full-time