Provider Education & Consultation Consultant – LPN, LVN, RN

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

📋 Description

• Engages with and informs providers about Medicare coverage, utilization metrics, documentation, and medical review through written communications, reports, letters, and phone calls.

• Records provider interactions and communications within the provider tracking system.

• Facilitates formal conference calls and in-person educational visits with providers who demonstrate service overutilization, are undergoing progressive corrective measures, or exhibit unacceptable denial or error rates.

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

• Researches, develops, and coordinates provider education materials based on regulatory requirements.

• Evaluates effective reports to determine necessary actions concerning medical review audits.

• Identifies providers and services that are being overused.

• Collaborates with the medical review department, providing insights on actions related to provider billing practices.

• Focuses on providers where significant abuse of the Medicare program has been identified.

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

• Aids in training medical review associates on coverage and the medical review process.

• Works an 8-hour shift during standard business hours, Monday through Friday.

• Travels for in-person conferences and presentations and may occasionally work overtime.

⛳️ Requirements

• For LPN candidates, graduation from an accredited School of Licensed Practical Nursing is required.

• For LVN applicants, graduation from an accredited School of Licensed Vocational Nursing is necessary.

• For RN candidates, graduation from an approved School of Nursing is mandatory.

• If an LPN or LVN, a minimum of 7 years of clinical experience or a combination of clinical and educator experience is required.

• If an RN, at least 5 years of clinical experience or an equivalent combination of clinical and educator experience is necessary.

• Proficiency in Microsoft Office is essential.

• Understanding of medical terminology and disease processes is required.

• Demonstrated skill in word processing and spreadsheet software is necessary.

• Good judgment skills are essential.

• Effective skills in customer service, organization, and presentation are required.

• Strong proficiency in spelling, punctuation, and grammar is necessary.

• Analytical or critical thinking skills are required.

• Basic proficiency in business math is necessary.

• Knowledge of mathematical or statistical concepts is required.

• Ability to persuade, negotiate, or influence is essential.

• Active LPN or LVN licensure in the state of hire, or an active compact multistate LPN license according to the Nurse Licensure Compact (NLC), or active RN licensure in the state of hire, or an active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) is required.

• Ability to manage confidential or sensitive information with discretion is essential.

• Must be able 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.

• Preferred: Comprehensive knowledge of the Medicare program, guidelines, and regulations governing coverage.

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

🏝️ Benefits

• Subsidized health plans, including dental and vision coverage.

• 401k retirement savings plan with company contributions.

• Life insurance coverage.

• Paid Time Off (PTO).

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

• Education assistance programs.

• Recognition for years of service.

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