Senior Provider Education Consultant – IRF RCD

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🕒 Setembro 10

🏈 Alabama, Tennessee – Remoto

🏈 Alabama – Remote 🎸 Tennessee – Remote

⏰ Tempo Integral

🟠 Sênior

💼 Consultor

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Palmetto GBA

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1965

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

A Palmetto GBA é uma das maiores provedoras do país em processamento em grande volume de reivindicações e transações do Medicare, operações de contact center e serviços técnicos para programas federais de saúde e clientes comerciais. A empresa atua como um Contratante Administrativo do Medicare (MAC) e oferece suporte a inscrição, adjudicação de reivindicações, serviços para provedores e beneficiários, programas especializados (por exemplo, DMEPOS, Cuidados em Casa & Hospício, Medicare Ferroviário), análise de preços e codificação, e funções de administrador terceirizado. Com sede em Columbia, Carolina do Sul, a Palmetto GBA opera em várias jurisdições do Medicare e faz parte do Grupo Celerian.

Descrição

• Provide education to medical providers as warranted • Communicate and educate providers on Medicare coverage, utilization statistics, documentation, and medical review through written advisories, reports, letters, and telephone contacts • Document all provider contacts and communications in the provider tracking system • Conduct formal conference calls and in-person educational visits with providers who over-utilize services, are on progressive corrective action, or have unacceptable denial or error rates • Conduct coverage and documentation workshops for Medicare providers and physicians’ staff • Research, compose, and coordinate regulatory-based provider education materials • Analyze effective reports to determine actions regarding medical reviews and audits • Determine which providers and services are being over-utilized • Work with the medical review department and provide input regarding actions taken in response to provider billing practices • Target providers where the greatest abuse of the Medicare program has occurred • Participate in the medical review process and inter-reviewer reliability studies • Assist in training medical review associates on coverage and medical review processes • Work an 8-hour shift during normal business hours of 8 a.m.–5 p.m.

🎯 Requisitos

• Must reside in Alabama, Georgia, or Tennessee • Must be able to travel up to 3–5 days a week, including possible weekday and weekend overnight travel • Position is not eligible for sponsorship now or in the future • If LPN, graduate of an accredited School of Licensed Practical Nursing • If LVN, graduate of an accredited School of Licensed Vocational Nursing • If RN, graduate of an approved School of Nursing • If LPN or LVN, 7 years of clinical experience or equivalent combination of clinical and educator experience • If RN, 5 years of clinical experience or equivalent combination of clinical and educator experience • Knowledge of medical terminology and disease processes • Proficiency in word processing and spreadsheet software • Good judgment skills • Customer service, organizational, and presentation skills • Proficiency in spelling, punctuation, and grammar • Analytical or critical thinking skills • Basic business math proficiency • Knowledge of mathematical or statistical concepts • Ability to persuade, negotiate, or influence others • Ability to handle confidential or sensitive information with discretion • Microsoft Office proficiency • Active LPN or LVN licensure in the state hired, active compact multistate LPN license under the Nurse Licensure Compact, active RN licensure in the state hired, or active compact multistate RN license under the Nurse Licensure Compact • Preferred: 3 years of provider relations and Medicare experience • Preferred: IRF (Inpatient Rehabilitation Facility) education consultant experience • Preferred: Knowledge of claims processing software • Preferred: In-depth knowledge of Medicare program, guidelines, and regulations governing coverage • Preferred: Working knowledge of Microsoft Access or other database software

🏖️ Benefícios

• Subsidized health plans, dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more • Diverse and inclusive workplace with opportunities to develop skills, advance careers, and contribute to company growth • Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs

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