Provider Education & Consultation Consultant – LPN, LVN, RN

This is a fully remote position, open to applicants in Alabama, +2 more states.

📋 Description

• Educate medical providers as necessary.

• Inform and educate providers about Medicare coverage, utilization statistics, documentation, and medical reviews through written advisories, reports, correspondence, and phone calls.

• Record provider interactions and communications in the provider tracking system.

• Facilitate formal conference calls and conduct in-person educational visits with providers who exhibit overutilization of services, are under progressive corrective action, or have high denial or error rates.

• Organize coverage and documentation workshops for Medicare providers and their staff.

• Research, create, and coordinate education materials based on regulatory requirements for providers.

• Analyze reports to identify necessary actions regarding medical reviews and audits.

• Identify which providers and services are subject to overutilization.

• Collaborate with the medical review department and contribute to responses regarding provider billing practices.

• Focus on providers where significant Medicare program abuse has been identified.

• Engage in the medical review process and participate in inter-reviewer reliability studies.

• Aid in training medical review associates on coverage and medical review procedures.

• Work an 8-hour shift during the hours of 8:00 a.m. to 5:00 p.m., Monday to Friday.

• Occasionally travel for in-person conferences and presentations; be open to working overtime as required.

⛳️ Requirements

• LPN: completion of an accredited School of Licensed Practical Nursing; LVN: completion of an accredited School of Licensed Vocational Nursing; RN: completion of an approved School of Nursing.

• LPN or LVN: 7 years of clinical experience or a suitable combination of clinical and educational experience.

• RN: 5 years of clinical experience or a suitable combination of clinical and educational experience.

• Proficiency in Microsoft Office.

• Familiarity with medical terminology and disease processes.

• Proven skills in word processing and spreadsheet software.

• Strong judgment skills.

• Excellent customer service, organizational, and presentation abilities.

• High proficiency in spelling, punctuation, and grammar.

• Analytical or critical thinking abilities.

• Basic proficiency in business mathematics.

• Understanding of mathematical or statistical concepts.

• Capability to persuade, negotiate, or influence.

• Active LPN or LVN licensure in the hiring state, active compact multistate LPN license under the Nurse Licensure Compact, active RN licensure in the hiring state, or active compact multistate RN license under the Nurse Licensure Compact.

• Ability to manage confidential or sensitive information with discretion.

• Capacity to obtain a security clearance; applicants must be U.S. Citizens.

• Preferred: 3 years of experience in provider relations and Medicare.

• Preferred: familiarity with claims processing software and comprehensive knowledge of Medicare programs, guidelines, and coverage regulations.

• Preferred: working knowledge of Microsoft Access or other database software.

🏝️ Benefits

• Subsidized health plans, along with dental and vision coverage.

• 401k retirement savings plan with company matching.

• Life Insurance coverage.

• Paid Time Off (PTO).

• On-site cafeterias and fitness centers available at major locations.

• Educational Assistance provided.

• Service Recognition programs.

• National discounts for movies, theaters, zoos, theme parks, and more.