Sr Manager- Provider Relations (Medicaid & Med/Surg)

Requisition ID: 817282 
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. Manager, Provider Experience is responsible for serving as the subject matter expert for the government, medical and surgical lines of business within the provider experience organization. Key focus on building sustainable relationships with doctors and their staff through various communication channels to drive improved experiences and overall satisfaction. The Sr. Manager will work directly with the Director of Provider Experience to ensure the coordination and function of all operational components of medical/surgical eye care are meeting our network expectations. This position assists in developing and executing the strategy and performance related to the end-to-end experience of participating providers.

MAJOR DUTIES AND RESPONSIBILITIES

• Manages provider relationships and is accountable for critical interface with providers and business staff in regards to government, medical and surgical networks when highly escalated requests/issues warrant
• Ensure the accurate implementation and day-to-day administration of the provider groups, often partnering and working cross functional with internal teams
• Manages and oversees compliance with our network responsibilities as provided within the State Medicaid and MCO contractual requirements

• Partners with the grievance and appeals department to track and resolve provider grievances, review claim denial/rejection appeals and identify trends in order to proactively mitigate future concerns
• Leads effective provider onboarding and training to use our systems and claim submissions and to service our members with understanding of plan benefits and code procedures
• Partners with business development teams to ensure client and member expectations are met in regards to overall network health and provider satisfaction metrics

• Works closley with the network and product team to ensure new member plan designs and corresponding provider fee schedules align with provider expectations
• Collaborates with the government recruiting team to ensure provider support readiness for the implementation and onboarding of large recruiting projects
• Partners with government compliance team to fully understand and ensure operationalization of and compliance with legislative changes

BASIC QUALIFICATIONS

• Bachelor’s Degree or equivalent work experience
• 8+ years business experience
• Demonstrated ability to problem solve complex, multifaceted situations
• Strong sense of urgency with the ability to juggle multiple requests/projects, organize and prioritize based on situation
• Well-developed interpersonal skills. Ability to get along with diverse personalities and backgrounds
• Computer literacy on Microsoft Office products

PREFERRED QUALIFICATIONS

• Advanced Degree
• Experience in network development/management, provider relations, utilization management, acute care and/or a medical/surgical office/facility

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/Incentive Information including health benefits, PTO, 401K, paid family leave, tuition reimbursement, and eyewear 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 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) 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 receive preference in accordance with Tribal Law.