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

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

📋 Description

• Engage and inform providers about Medicare coverage, utilization statistics, documentation, and medical review through written advisories, reports, letters, and phone communications.

• Keep a record of all provider interactions and communications within the provider tracking system.

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

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

• Research, prepare, and coordinate provider education materials rooted in regulatory requirements.

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

• Identify which providers and services are experiencing overutilization.

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

• Focus on providers linked to the highest levels of Medicare program abuse.

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

• Provide training support to medical review associates on coverage and medical review procedures.

• May require travel between office locations, to and from provider facilities, and within or outside the state.

⛳️ Requirements

• 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, at least 7 years of clinical experience or a comparable mix of clinical and educational experience.

• If RN, at least 5 years of clinical experience or an equivalent blend of clinical and educational experience.

• Familiarity with medical terminology and disease processes.

• Proven proficiency in word processing and spreadsheet applications.

• Strong judgment skills.

• Excellent customer service, organizational, and presentation abilities.

• Demonstrated accuracy in spelling, punctuation, and grammar.

• Analytical and critical thinking skills.

• Basic proficiency in business mathematics.

• Understanding of mathematical or statistical principles.

• Capability to persuade, negotiate, or influence others.

• Ability to manage confidential or sensitive information with discretion.

• Proficient in Microsoft Office.

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

• Eligibility to work in South Carolina, North Carolina, Georgia, or Alabama.

• Previous experience with Medicare preferred.

• Familiarity with claims processing software preferred.

• In-depth understanding of the Medicare program, guidelines, and regulations governing coverage preferred.

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

• This position is not eligible for 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, career advancement, and contributions to company growth.