Provider Education & Consultation Consultant – LPN, LVN, RN

Job not on LinkedIn

🔥 12 hours ago

🏈 Alabama, North Carolina, +1 more states – Remote

🏈 Alabama – Remote 🌲 North Carolina – Remote 🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Palmetto GBA

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1965

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Palmetto GBA is one of the nation's largest providers of high-volume Medicare claims and transaction processing, contact center operations, and technical services for federal healthcare programs and commercial customers. The company serves as a Medicare Administrative Contractor (MAC) and supports enrollment, claims adjudication, provider and beneficiary services, specialized programs (e. g. , DMEPOS, Home Health & Hospice, Railroad Medicare), pricing and coding analysis, and third-party administrator functions. Headquartered in Columbia, South Carolina, Palmetto GBA operates across multiple Medicare jurisdictions and is part of the Celerian Group.

📋 Description

• Communicates and educates providers on Medicare coverage, utilization statistics, documentation, and medical review through written advisories, reports, letters, and telephone contacts • Documents provider contacts and communications in the provider tracking system • Conducts formal conference calls and in-person educational visits with providers who overutilize services, are under progressive corrective action, or have unacceptable denial or error rates • Conducts coverage and documentation workshops for Medicare providers and physicians’ staff • Researches, composes, and coordinates regulatory-based provider education materials • Analyzes effective reports to determine actions regarding medical review audits • Determines which providers and services are being overutilized • Works with the medical review department and provides input on actions related to provider billing practices • Targets providers where the greatest abuse of the Medicare program has occurred • Participates in the medical review process and inter-reviewer reliability studies • Assists in training medical review associates on coverage and the medical review process • Works an 8-hour shift during normal business hours, Monday–Friday • Travels for in-person conferences and presentations and may work occasional overtime

🎯 Requirements

• If LPN, graduate of accredited School of Licensed Practical Nursing • If LVN, graduate of accredited School of Licensed Vocational Nursing • If RN, graduate of 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 • Microsoft Office • Knowledge of medical terminology and disease processes • Demonstrated proficiency in word processing and spreadsheet software • Good judgment skills • Effective customer service, organizational, and presentation skills • Demonstrated 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 • Active LPN or LVN licensure in state hired, or active compact multistate LPN license as defined by the Nurse Licensure Compact (NLC), or active RN licensure in state hired, or active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) • Ability to handle confidential or sensitive information with discretion • Ability to obtain a security clearance; applicants must be U.S. Citizens • Preferred: 3 years of provider relations and Medicare 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

🏖️ Benefits

• 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