Job Description

Requisition ID: 875809  
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 Medicaid EDI Manager will play a critical role within the Business Data Solutions team to maintain and implement Medicaid encounter feeds. The Medicaid Manager will be the primary resource implementing new client and/or state outbound transactions. The Manager will develop requirements based on stakeholder meetings and interpretation of Companion Guides. The Manager will identify, recommend and implement process improvements in support of the EDI system based on observation, monitoring and external inquiries regarding EDI issues. Other responsibilities include researching and analyzing encounter edits or rejections for Medicaid clients and work with internal/external teams to resolve. The Manager will work to improve overall encounter, member and provider data quality, as well as track encounter submission quality and timeliness.

MAJOR DUTIES AND RESPONSIBILITIES

• Research and analyze Encounter Edits or Rejections to identify trends and root cause
• Collaborate with other departments to research, identify and correct data errors to minimize ongoing rejection risk
• Maintain compliance to all company and regulatory policies
• Provide support during and after implementation for HIPAA claims-based EDI transactions
• Respond to inquiries regarding EDI issues with encounter claims and trading partner activities
• Ensures all outbound 837 transactions return appropriate responses (999, 277CA, custom)
• Develop standard and custom testing plans to ensure compliance with requirements
• Develop and execute test scripts related to EDI transactions
• Conducts QA and testing on EDI applications
• Management of catalog of EDI Companion Guides such as 837, 999, 277CA, 835
• Maintain detailed documentation and process flow of all EDI processes
• Support Account Management group with EDI related issues
• Identifies, recommends and implements process improvements in support of the EDI system
• Request and maintain SFTP connections and rules including resolving transmission problems with partners

BASIC QUALIFICATIONS

• Bachelor’s Degree or equivalent work experience
• 5+ years EDI Transactions experience
• High degree of business and technical knowledge with significant practical experience in Insurance Claims processing
• Data analysis and troubleshooting
• SQL Developer- build and execute select statements
• Data testing
• Requirements definition and management
• Basic Project management

PREFERRED QUALIFICATIONS

• HIPAA X12 EDI Transactions experience
• Experience with EDI mapping for 837, 999, 277CA, 835
• GlobalScape/Secured File Transfer Protocol (SFTP)
• Trizetto Facets
• SAP BusinessObjects Web Intelligence

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 [email protected]. 

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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