Senior Provider Education Consultant, LPN, LVN, RN

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Educate and communicate with healthcare providers regarding Medicare coverage, utilization metrics, documentation requirements, and medical review through advisories, reports, letters, and phone interactions.

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

• Conduct formal conference calls and/or in-person educational sessions with providers facing overutilization, progressive corrective actions, or unacceptable denial/error rates.

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

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

• Analyze reports to inform decisions related to medical reviews and audits.

• Identify providers and services that are experiencing over-utilization.

• Collaborate with the medical review department and contribute insights on responses to provider billing practices.

• Focus on providers with a significant history of Medicare program abuse.

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

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

• Reach out to selected physicians, hospitals, clinics, and other healthcare providers for TPE reviews; clarify selection, documentation requirements, and subsequent steps.

⛳️ Requirements

• LPN: must be a graduate from an accredited School of Licensed Practical Nursing.

• LVN: must be a graduate from an accredited School of Licensed Vocational Nursing.

• RN: must be a graduate from an approved School of Nursing.

• LPN or LVN: a minimum of 7 years of clinical experience or a comparable combination of clinical and educational experience.

• RN: at least 5 years of clinical experience or a similar 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 skills in customer service, organization, and presentations.

• Proficient in spelling, punctuation, and grammar.

• Strong analytical or critical thinking abilities.

• Basic proficiency in business math.

• Understanding of mathematical or statistical concepts.

• Capable of persuading, negotiating, or influencing others.

• Skilled in managing confidential or sensitive information with care.

• Proficient in Microsoft Office.

• Current LPN or LVN licensure in the state of employment, or an active compact multistate LPN license under the Nurse Licensure Compact (NLC).

• Current RN licensure in the state of employment, or an active compact multistate RN license under the Nurse Licensure Compact (NLC).

• Preferably, experience with Medicare.

• Familiarity with claims processing software is preferred.

• In-depth understanding of Medicare programs, guidelines, and coverage regulations is preferred.

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

• Must not require sponsorship now or in the future.

🏝️ Benefits

• Subsidized health plans, including dental and vision coverage.

• 401k retirement savings plan with company matching.

• Life insurance coverage.

• Paid Time Off (PTO).

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

• Education assistance programs.

• Service recognition initiatives.

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

• A diverse and inclusive workplace offering opportunities for skill development and career advancement.

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