Senior Consultant, Provider Education

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

📋 Description

• Engage with and educate healthcare providers regarding Medicare coverage, utilization metrics, documentation, and medical reviews through advisories, reports, letters, and phone communications.

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

• Facilitate formal conference calls and conduct in-person educational visits with providers who are over-utilizing services or demonstrating unacceptable denial or error rates.

• Organize coverage and documentation workshops for Medicare providers and the staff of physicians.

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

• Analyze reports to make informed decisions regarding medical reviews and audits.

• Identify providers and services that are being over-utilized.

• Collaborate with the medical review department and offer insights on actions pertaining to provider billing practices.

• Focus on providers linked to the highest levels of Medicare program abuse.

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

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

⛳️ Requirements

• This is a full-time remote position available for candidates located in South Carolina, North Carolina, Georgia, and Alabama.

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

• For LVN candidates, graduation from an accredited School of Licensed Vocational Nursing is required.

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

• If LPN or LVN, at least 7 years of clinical experience or a comparable combination of clinical and educational experience is necessary.

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

• Familiarity with medical terminology and disease processes is essential.

• Proficiency in word processing and spreadsheet applications is required.

• Strong judgment skills are necessary.

• Excellent customer service, organizational, and presentation skills are required.

• Proficient spelling, punctuation, and grammar skills are a must.

• Analytical or critical thinking capabilities are needed.

• Basic business math skills are essential.

• Understanding of mathematical or statistical concepts is required.

• Ability to persuade, negotiate, or influence others is needed.

• Capability to manage confidential or sensitive information with discretion is required.

• Proficiency in Microsoft Office is expected.

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

• Experience with Medicare is preferred.

• Familiarity with claims processing software is preferred.

• Comprehensive knowledge of the Medicare program, guidelines, and regulations governing coverage is preferred.

• Working knowledge of Microsoft Excel, Microsoft Access, or other database software is preferred.

• No eligibility for current or future sponsorship is permitted.

🏝️ Benefits

• Subsidized health plans, including dental and vision coverage.

• 401k retirement savings plan with company matching contributions.

• Life insurance coverage.

• Paid Time Off (PTO) policy.

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

• Education assistance programs.

• Service recognition initiatives.

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

• A diverse and inclusive workplace that offers opportunities to enhance skills, advance careers, and contribute unique talents.