Requisition ID: 888726
Store #: 113004 EM Payment Integrity - 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

The Specialist of the Provider Data production team is responsible for the contract, network, tax entity, servicing location(s), and rendering provider setup for EyeMed’s network of providers. Provide subject matter expertise for provider, agreement and network set configuration in Facets. Partner with EyeMed cross functional teams to ensure efficiency and accuracy of provider data requests

MAJOR DUTIES AND RESPONSIBILITIES

• Set up new and maintain structures for new and existing providers into the core Facets system.
• Execute end to end standard and custom new provider configuration to support run the business activities, recruiting and other strategic network initiatives to support network growth.
• Configure and maintain all types of providers according to contracting and system guidelines including independent providers, RONA doctors and stores, retail chains, and other strategic provider groups (Vision Source, EL360)
• Follow the established corporate and industry audit controls when fulfilling setup and maintenance requests.
• Coordinate with research team to perform testing and validation of new or existing provider configuration requests to ensure accurate end to end processes for providers that align to the contracted networks and pricing.
• Perform research to troubleshoot provider issues and communicate with research lead and Provider OSM team to resolve escalations and requests sent to the provider data team.
• Maintain relationships with the provider OSM team, provider segment leaders, credentialing, claims, business transformation and other functional areas to develop a cohesive cross functional, results driven working environment.
• Complete work inventory in the production queues within established quality and turnaround time guidelines.
• Coordinate and participate in cross-functional team activities for issue resolution. Recommend process and system enhancements for the production team to drive improvements.
• Support the management team with on-going training activities, projects, resolving issues, and serving as a subject matter expert for provider data configuration requests.
• Maintain understanding of intersystem dependencies of provider data including Ciao, locator, Exclaim, PNAM, Facets and Webfacets.

BASIC QUALIFICATIONS

• College degree or equivalent work experience
• At least 2 years of experience working within a Healthcare claims processing system
• Good analytical and problem-solving skills
• Good communication and interpersonal skills
• Ability to work independently and with others
• Ability to manage multiple assignments at the same time

PREFERRED QUALIFICATIONS

• 2+ years’ experience in Operations in the Healthcare industry
• Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration
• Knowledge of Medicare and Medicaid programs

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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