Administrator - Operations (Audit Execution)

Requisition ID:889193

Store #:113024 EM Ops Compliance - OH CSC

Position:Full-Time

Total Rewards:Benefits/Incentive Information

At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use.

Our mission is to help people see life to the fullest-and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world's vision crisis.

EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.

GENERAL FUNCTION

The Audit Administrator is responsible for the preparation, delivery, and participation in low to moderate volume/complex client audits that review all processes within Operations. The Administrator is accountable for any follow-up activities that may result from audit findings, including developing Corrective Action Plan (CAP) responses and their timely completion. The Administrator will collaborate with business leaders and audit teams to ensure compliance, and coordinate with the Audit Execution Specialist to ensure timely and accurate delivery of business packet evidence.

MAJOR DUTIES AND RESPONSIBILITIES

• Collaborate with the Audit Management Team in preparing for and delivering client audits.
• Represent the Operations departments in low to moderate volume/complex client audits, including delivering audit deliverables, response documentation, case development, webinar presentation, and all other audit activity as needed.
• Assist Audit Execution Managers with documenting and maintaining accurate & up-to-date processes and regulations that impact the team's scope and deliverables.
• Support claims/payment research for audit follow-up questions.
• Organize and document evidence for audits and inquiries.
• Maintain team Knowledge Base documentation to ensure consistency across all audit/corrective action responses.
• Collaborate with Audit Execution Managers to ensure consistent issue resolution.
• Partner with EyeMed IT to manage and improve documentation automation.
• Identify and resolve automation issues found during quality checks.
• Maintain and enhance automation documentation.
• Lead efforts to improve audit processes through automation.
• Manage and standardize packet documentation requests to meet deadlines.
• Maintain strict adherence to all HIPAA and corporate data security guidelines/regulations.

BASIC QUALIFICATIONS

• Bachelor's Degree or equivalent work experience
• 3+ years of related experience in Health/Vision Care Compliance or Operations based organization
• Analytical approach to process review and results
• Demonstrated project management skills
• Collaborative work style with the ability to build partnerships, teamwork, and good working relationships
• Demonstrated ability to deal with confidential information
• Ability to effectively present information and respond to questions from peers and management
• Ability to work in a fast-paced environment with changing priorities
• Intermediate-level experience with Microsoft Office Products (Word, PowerPoint, Excel)

PREFERRED QUALIFICATIONS

• Knowledge of the Medicare Advantage (MA) and Medicaid regulatory regulations
• Experience in performing effective monitoring and oversight
• Understanding of the regulatory framework within which the company operates
• Experience with the Facets Core platform, specifically Medical Claims Processing

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 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 in the US receive preference in accordance with Tribal Law.