Senior Provider Education Consultant, LPN, LVN, RN - Medicare Experience

This is a fully remote position, open to applicants in United States.

📋 Description

• Engages with and educates providers regarding Medicare coverage, utilization data, documentation, and medical review via written advisories, reports, letters, and telephone interactions.

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

• Facilitates formal conference calls and/or in-person educational visits with providers who demonstrate service over-utilization, are undergoing progressive corrective action, or exhibit high denial or error rates.

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

• Researches, develops, and coordinates educational materials for providers based on regulatory standards.

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

• Identifies providers and services that are excessively utilizing services.

• Collaborates with the medical review department and offers insights on actions taken in relation to provider billing practices.

• Focuses on providers where significant Medicare program abuse has been identified.

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

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

⛳️ Requirements

• Graduate of an accredited School of Licensed Practical Nursing if LPN, accredited School of Licensed Vocational Nursing if LVN, or an approved School of Nursing if RN.

• If LPN or LVN, a minimum of 7 years of clinical experience or a comparable mix of clinical and educational experience.

• If RN, a minimum of 5 years of clinical experience or a comparable mix of clinical and educational experience.

• Familiarity with medical terminology and disease processes.

• Proven expertise in word processing and spreadsheet applications.

• Strong judgment skills.

• Excellent customer service, organizational, and presentation abilities.

• Proven accuracy in spelling, punctuation, and grammar.

• Strong analytical or critical thinking skills.

• 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 hire, active compact multistate LPN license under the Nurse Licensure Compact, active RN licensure in the state of hire, or active compact multistate RN license under the Nurse Licensure Compact.

• Medicare experience is preferred.

• Familiarity with claims processing software is preferred.

• Extensive knowledge of the Medicare program, guidelines, and regulations governing coverage is preferred.

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

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

🏝️ 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 at major locations.

• Education Assistance.

• Service Recognition.

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

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