Senior Provider Education Consultant – IRF RCD

This is a fully remote position, open to applicants in Alabama, +1 more state.

📋 Description

• Educate medical providers as necessary.

• Inform and instruct providers about Medicare coverage, utilization statistics, documentation, and medical reviews through written advisories, reports, letters, and phone communications.

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

• Facilitate formal conference calls and/or in-person educational visits with providers who consistently overutilize services, are undergoing progressive corrective action, or exhibit unacceptable denial/error rates.

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

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

• Analyze effective reports to inform actions related to medical reviews and audits.

• Identify which providers are overutilizing services and which services are being overused.

• Collaborate with the medical review department and provide input regarding actions in response to provider billing practices.

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

• Participate in the medical review process and inter-reviewer reliability (IRR) studies.

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

• Work an 8-hour shift during standard business hours of 8 a.m.–5 p.m.

⛳️ Requirements

• If Licensed Practical Nurse (LPN), graduate of an accredited School of Licensed Practical Nursing; if Licensed Vocational Nurse (LVN), graduate of an accredited School of Licensed Vocational Nursing; if Registered Nurse (RN), graduate of an approved School of Nursing.

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

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

• Familiarity with medical terminology and disease processes.

• Proven proficiency in word processing and spreadsheet applications.

• Strong judgment skills.

• Effective customer service, organizational, and presentation abilities.

• Demonstrated proficiency in spelling, punctuation, and grammar.

• Strong analytical or critical thinking capabilities.

• Basic proficiency in business mathematics.

• Understanding of mathematical or statistical concepts.

• Ability to persuade, negotiate, or influence others.

• Capacity to handle confidential or sensitive information with discretion.

• Proficiency in Microsoft Office.

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

• Must reside in Alabama, Georgia, or Tennessee.

• Must be willing to travel up to 3-5 days a week, including possible overnight travel on weekdays and weekends.

• This position is not eligible for sponsorship now or in the future.

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

• Preferred: Familiarity with claims processing software and in-depth knowledge of Medicare programs, guidelines, and regulations governing coverage.

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

🏝️ Benefits

• Subsidized health plans, dental, and vision coverage.

• 401k retirement savings plan with company match.

• Life Insurance.

• Paid Time Off (PTO).

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

• Education Assistance.

• Service Recognition.

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

• A diverse and inclusive workplace with opportunities for skill development, career advancement, and contributions to company growth.

• Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs.