Senior Provider Education Consultant, LPN, LVN, RN

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

📋 Description

• Engage and educate healthcare providers regarding Medicare coverage, utilization statistics, documentation, and medical review via advisories, reports, letters, and phone interactions.

• Record all communications with providers in the provider tracking system.

• Facilitate conference calls and/or in-person educational meetings with providers involved in overutilization, progressive corrective actions, or unacceptable denial/error rates.

• Conduct workshops focused on coverage and documentation for Medicare provider staff and physicians’ teams.

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

• Analyze reports to inform actions concerning medical reviews and audits.

• Identify which providers and services exhibit signs of over-utilization.

• Collaborate with the medical review department and contribute insights regarding provider billing practices.

• Focus on providers with the highest instances of Medicare program abuse.

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

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

⛳️ Requirements

• LPN: completion of an accredited School of Licensed Practical Nursing; LVN: completion of an accredited School of Licensed Vocational Nursing; RN: graduation from an approved School of Nursing.

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

• RN: 5 years of clinical experience or a similar combination of clinical and educational experience.

• Familiarity with medical terminology and disease processes.

• Competence in word processing and spreadsheet applications.

• Strong judgment skills.

• Customer service, organizational, and presentation abilities.

• Proficient in spelling, punctuation, and grammar.

• Analytical or critical thinking capabilities.

• Basic proficiency in business mathematics.

• Understanding of mathematical or statistical concepts.

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

• Capacity to manage confidential or sensitive information with care.

• Proficient in Microsoft Office.

• Active LPN or LVN licensure in the state of employment or active compact multistate LPN/LVN 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.

• Ineligible for sponsorship now or in the future.

• Preferably experienced in Medicare.

• Familiarity with claims processing software is preferred.

• Extensive knowledge of Medicare programs, guidelines, and coverage regulations is preferred.

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

🏝️ Benefits

• Subsidized health plans, dental, and vision coverage.

• 401k retirement savings plan with company matching.

• Life Insurance.

• Paid Time Off (PTO).

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

• Education Assistance.

• Service Recognition.

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

• A diverse and inclusive workplace that offers opportunities to develop skills, advance careers, and contribute to the growth of the company.

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