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Senior Payments Specialist

Date:  Jan 14, 2022
Brand:  EyeMed Vision Care
Location: 

Mason, OH, US, 45040

Requisition ID: 484801 
Position:Full-Time
Total Rewards: Benefits/Incentive Information

 

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 FUNCTION

The Sr. Payments Analyst is responsible for claims and payments related regulatory correspondence through the execution of report creation/maintenance, data analysis and outgoing provider and member communication. The role will drive cross-functional project initiatives, issue resolution and process improvement efforts with various functional areas in the organization. Responsible for identifying risks, communicating issue resolution and status updates to Operations leadership.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Create, maintain, and implement all EyeMed and client specific EOB & IDN (Integrated Denial Notices) templates, incorporating translated EOBs in compliance with California Language Assistance laws.
  • Responsible for the regulatory processes, projects / initiatives and process improvements, including but not limited to: EOBs, IDNs, 1099’s, IRS-B notification, Provider Term Letters, Humana Non-Par/AOB, Preclusion Letters, Medicare Denial Letters, Acknowledgement letters, etc.
  • Collaborate with internal and external business partners to develop and maintain accurate and appropriate member and/or provider communications, ensuring client needs and regulatory demands are central to all efforts.
  • Maintain relationships with multiple third-party fulfillment vendors guaranteeing the vendors' contracted functions are performed effectively, all contracted SLAs are met, and projects are delivered timely & accurately.
  • Create Business Objects reports to research any issues, provide a summary of findings, trends and gap analysis to Payments and/or EyeMed leadership.
  • Identify and recommend systems/process improvements necessary to gain efficiency and effectiveness; provides project management oversight in the execution of these recommendations.
  • Work cross-functionally to research and resolve all issues accurately and in a timely manner. Ensure management and employees are kept informed.
  • Identify, analyze and confirm all external communications are distributed correctly, timely and accurately to ensure regulatory requirements and deliverables are being met
  • Document and maintain any business and system requirements and processes.
  • Ensure all regulatory and CMS requirements are current in relation to outgoing provider and member communication.
  • Monitor applicable budget expenses including, but not limited to: creation of purchase orders, submission of vendor invoices for payment, tracking of expense actuals and accruals.

BASIC QUALIFICATIONS

  • Bachelor's Degree or equivalent work experience
  • 3+ years of analysis experience with query writing and/or report building
  • Strong analytical skills
  • Knowledge of Business Objects
  • Highly proficient in Excel
  • Strong communication, problem solving, teamwork and organization skills

 

PREFERRED QUALIFICATIONS

  • Bachelor's Degree in IT related field or Analytics
  • 5+ years of analysis experience
  • 5+ years of experience with query writing and/or report building
  • Knowledge of SQL Data Extraction

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 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). 

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 receive preference in accordance with Tribal Law.


Nearest Major Market: Cincinnati

Job Segment: Medicare, Business Process, Healthcare, Management

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