Senior Consultant, Provider Education

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

📋 Description

• Engages and informs providers about Medicare coverage, utilization data, documentation, and medical review through various communication methods, including written advisories, reports, letters, and phone calls.

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

• Facilitates formal conference calls and in-person educational sessions with providers exhibiting service overutilization, progressive corrective actions, unacceptable denial rates, or high error rates.

• Organizes coverage and documentation workshops aimed at Medicare providers and physicians' staff.

• Investigates, drafts, and coordinates educational materials for providers based on regulatory requirements.

• Evaluates reports to inform decisions regarding medical reviews and audits.

• Identifies providers and services experiencing over-utilization.

• Collaborates with the medical review department and offers insights on provider billing practices.

• Focuses on providers with significant abuse of the Medicare program.

• Engages in the medical review process and inter-reviewer reliability assessments.

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

• Works an 8-hour shift during the standard business hours of 8:30 a.m. to 5 p.m.; may require travel to provider locations within or outside the state.

⛳️ Requirements

• For LPNs, must be a graduate of an accredited School of Licensed Practical Nursing; for LVNs, must be a graduate of an accredited School of Licensed Vocational Nursing; for RNs, must be a graduate of an approved School of Nursing.

• If LPN or LVN, requires 7 years of clinical experience or an equivalent combination of clinical and educational experience.

• If RN, requires 5 years of clinical experience or an equivalent combination of clinical and educational experience.

• Familiarity with medical terminology and disease processes.

• Proven proficiency with word processing and spreadsheet software.

• Strong judgment skills.

• Excellent customer service, organizational, and presentation abilities.

• Demonstrated proficiency in spelling, punctuation, and grammar.

• Strong analytical or critical thinking skills.

• Basic proficiency in business math.

• Understanding of mathematical or statistical principles.

• Ability to persuade, negotiate, or influence others effectively.

• Capability to manage confidential or sensitive information with discretion.

• Proficiency in Microsoft Office.

• Must hold an active LPN or LVN license in the state of employment, or an active compact multistate LPN license as defined by the Nurse Licensure Compact (NLC), or an active RN license in the state of employment, or an active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

• Medicare experience is preferred.

• Familiarity with claims processing software is preferred.

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

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

• Sponsorship is not available now or in the future.

🏝️ 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 at major locations.

• Education assistance programs.

• Service recognition initiatives.

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