Requisition ID : 843802

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 Medical Claims Coordinator is responsible for monitoring insurance carrier adjudication of TeamVision medical claims for one or more doctor practices.

Utilize a practice EHR system and clearing house to review and submit claims to multiple insurance carriers Review open / unpaid claim balances and take required action.

MAJOR DUTIES & RESPONSIBILITIES

• Review medical claims and transmit to the insurance carrier using the practice electronic health records (EHR) system and clearing house.
• Monitor rejected claim reports and adjust claims for resubmission to the insurance carrier.
• Download insurance carrier evidence of benefits (EOBs) to post claim payments and denials in the EHR system.
• Determine if denied claims can be adjusted and re-submitted to the carrier.
• Review aging reports to research open balances and resubmit within insurance carrier filing limits.
• Utilize insurance carrier websites and contact carriers as needed to investigate denials and claim status.
• Partner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system.
• Initiate overpayment refunds to patients and repayments to insurance carriers when required.
• Write-off open claim balances in the EHR system.
• Serve as the point of contact for the practice regarding all vision and medical claims.
• Support the corporate manager in maximizing claim collection rate.

BASIC QUALIFICATIONS

• High school diploma
• 3 years of related work experience
• Experience with medical vision claims and coding
• Ability to prioritize handling of issues
• Organization skills and ability to multitask
• Effective communication skills (verbal, written, listening, presentation)

PREFERRED QUALIFICATIONS

• Experience working in multiple doctor practices
• Experience working with multiple insurance carriers and an understanding of their claim requirements

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 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 in the US receive preference in accordance with Tribal Law.

Last updated : 2024-04-28