Share this Job

Manager, Provider Relations (Medical and Surgical Network Relationship Manager)

Date: Jun 12, 2019

Location: Mason, OH, US, 45040

Company: Luxottica Group

Requisition ID: 99719 
Position:Full-Time

 

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, Target Optical and Sears 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 FUNCTION

The Manager-Provider Relations (Medical and Surgical Network Relationship Manager) is responsible for the overall network health and provider relationship management for medical and surgical, including executing plans to align with and help drive sales strategy and responsibility for building and maintaining positive provider relationships. Key areas of focus include executing strategies to close network gaps, maximizing provider retention, increasing provider satisfaction and ensuring compliance with business and regulatory requirements.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Conduct ongoing outreach to ensure provider satisfaction and identify issues before escalation. Work with providers and staff to address administrative concerns or issues, resolving escalated provider issues
  • Coordinate with Utilization Management team, including analysts, nurses and physicians, to resolve clinical editing issues and questions from providers and billing staff
  • Coordinate with claims and payments team to resolve issues related to claims payments and remittance advice documentation
  • Secure effective provider onboarding, along with provider readiness to use our systems, clearinghouses, and claim submission portal, and to service members with understanding of plan benefits and code procedures
  • Secure provider knowledge to use our systems and claim submissions and to service our members with understanding of plan benefits and code procedures
  • Partner internally to develop provider communications and training materials, complying with all marketing collateral to deliver the Provider core story
  • Develop and implement appropriate network management project timelines in collaboration with sales team
  • Work to build a business case to provide recommended approach for reimbursement increases.
  • Maintains overall knowledge of state laws and regulations, including supporting plans to help drive network needs, gathering data for new state requirements and maintaining existing state requirements for Medicaid and Medicare.
  • Fully understand and ensure compliance with legislative changes as they apply to network management including contracts and processes

 

BASIC QUALIFICATIONS

  • Bachelor’s Degree
  • 5+ years experience, preferably in network development, provider relations, or sales/account management in the health care field
  • 25% travel required
  • Ability to work independently and set agenda for area of responsibility including prioritization of work, scheduling, tasks and projects
  • Ability to work constructively under pressure and think analytically in regards to operations and administrative processes
  • Ability to effectively manage the details of numerous customers simultaneously and properly set expectations with customers
  • Excellent communication skills, customer service, and ability to maintain composure and professionalism in stressful situations
  • Working knowledge of Microsoft Word, Excel, GroupWise

 

PREFERRED QUALIFICATIONS

  • Knowledge and understanding of plan benefit designs, standards of administration, managed vision care and network options, medical provider reimbursement methods
  • Knowledge of the private doctor community and billing and claims for professional services, outpatient, and inpatient facilities
  • Ability to engage with physicians in regards to service reimbursement and negotiations

 

Upon request and consistent with applicable laws, Luxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process. To request a reasonable accommodation, please contact Talent Luxottica at  877-589-8253 (513-765-2256 outside of US) or email TalentLuxottica@luxotticaretail.com

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, religion, age, disability, sexual orientation, gender identity or expression, citizenship, 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.

Sales / Account Management  

 


Nearest Major Market: Cincinnati

Job Segment: Medical, Manager, Surgery, Marketing Manager, Medicare, Healthcare, Management, Marketing