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Director- Insurance Compliance, Auditing

Date: 
Brand:  EyeMed Vision Care
Location: 

Mason, OH, US, 45040

Requisition ID: 129708 
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 Director- Compliance (Auditing) acts as primary point of contact for all client audits and manages the Auditing Compliance Team responsible for audit execution for both commercial and government segments. The Director is a Subject Matter Expert (SME) on the CMS audit rules and processes that drive client audits. The Director oversees responsibilities of the Auditing Compliance Team for client audit notifications; audit deliverable requests and progress updates; resulting corrective action communication; and the final audit closure notification and resulting processes. The Director communicates the results of each audit to the Compliance Officer and tracks the receipt of Corrective Action Plans (CAPs) and progress made in closing them.

 The Auditing Compliance Team supports the operational teams and leaders as a resource for all audit process questions, including the applicable CMS Audit protocols; audit logistics; timelines; research/analysis/interpretation of regulatory guidance; subjective CMS expectations; and best practices for performing in an audit.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Act as the Compliance point person for all EyeMed Client audits. including Medicare Advantage
  • Oversees team responsible for receipt, tracking and close-out all Client audits
  • Provides impactful guidance to the Audit team on the audit process, related rules and expectations, logistics and CMS audit protocols to the operational areas undergoing the audit.
  • Prepares accurate and timely formal written reports for the Compliance Officer on audit progress and outcomes, including findings and observations and any resulting Corrective Action Plans.
  • Tracks CAP progress and closure and pass to Monitoring Team for ongoing oversight.
  • Identifies and communicates potential/actual trends and outlier audit results.
  • Represents the Compliance Department on ad hoc teams as needed.
  • Provide ongoing oversight, direction, and performance management of the Audit Compliance Team, including mentoring and development of individual team members.
  • Provide regular feedback and coaching to team members.

 

BASIC QUALIFICATIONS

  • Bachelor’s Degree or equivalent
  • 10+ years of experience in regulatory auditing
  • 2+ years of experience in the MA Compliance industry
  • Experience in project oversight type role with demonstrated ability to drive implementation, manage multiple projects and influence others
  • Strong knowledge of the CMS Audit Protocols and the applicable CMS regulations, including auditing MA operational processes
  • Analytical approach to process review and results
  • Understanding of the regulatory framework within which the company operates
  • Strong written and verbal communication
  • Ability to effectively present information and respond to questions from peers and management
  • Ability to influence internal and external constituents
  • Collaborative workstyle with the ability to build partnerships, teamwork and good working relationships
  • Ability to work in a fast paced environment with changing priorities
  • Self-motivated, results-oriented, practical learning skills
  • Experience with Microsoft Office Products (Outlook, Word, PowerPoint, Excel, Access)

 

 PREFERRED QUALIFICATIONS

  • Certification in Healthcare Compliance (HCCA) preferred
  • Intermediate-level experience with Microsoft Project

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 or e-mail HRCompliance@luxotticaretail.com (be sure to provide your name and contact information for either option 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.


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