Senior Provider Education Consultant – IRF RCD

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

📋 Description

• Deliver education to medical providers as necessary

• Inform and educate providers about Medicare coverage, utilization statistics, documentation, and medical review through written advisories, reports, letters, and telephone communications

• Record provider interactions and communications in the provider tracking system

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

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

• Research, write, and organize regulatory-based educational materials for providers

• Analyze effective reports to determine necessary actions regarding medical reviews and audits

• Identify which providers and services are overutilizing resources

• Collaborate with the medical review department and offer input on actions taken regarding provider billing practices

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

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

• Support the training of medical review associates on coverage and the medical review process

⛳️ Requirements

• Must be a resident of Alabama, Georgia, or Tennessee

• Ability to travel up to 3-5 days per week

• Weekday and weekend overnight travel may be required

• This position is not eligible for sponsorship at present or in the future

• If LPN, must be a graduate of an accredited School of Licensed Practical Nursing

• If LVN, must be a graduate of an accredited School of Licensed Vocational Nursing

• If RN, must be a graduate of an approved School of Nursing

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

• If RN, a minimum of 5 years of clinical experience or an equivalent combination of clinical and educational experience is necessary

• Familiarity with medical terminology and disease processes

• Proven proficiency in word processing and spreadsheet software

• Strong judgment skills

• Excellent customer service, organizational, and presentation skills

• Demonstrated proficiency in spelling, punctuation, and grammar

• Strong analytical or critical thinking skills

• Basic proficiency in business math

• Understanding of mathematical or statistical concepts

• Ability to persuade, negotiate, or influence others

• Capability to handle confidential or sensitive information discreetly

• Proficient in Microsoft Office

• Active LPN or LVN licensure in the state of employment, or 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

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

• Preferred knowledge of claims processing software

• Preferred in-depth knowledge of the Medicare program, guidelines, and regulations governing coverage

• Preferred working knowledge of Microsoft Access or similar database software

🏝️ Benefits

• Subsidized health plans, as well as dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

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

• Education Assistance

• Service Recognition

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

• A diverse and inclusive workplace that fosters skill development, career advancement, and company growth

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