Senior Provider Education Consultant – IRF RCD

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🔥 0 minutes ago

🏈 Alabama, Tennessee – Remote

🏈 Alabama – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟠 Senior

💼 Consultant

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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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

• 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 provider contacts and communications in the provider tracking system • Conduct formal conference calls and/or in-person educational visits with providers who overutilize services, are under 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 overutilizing resources • 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 (IRR) studies • Assist in training medical review associates regarding coverage and the medical review process

🎯 Requirements

• Must reside in Alabama, Georgia, or Tennessee • Must be able to travel up to 3-5 days a week • Weekday and weekend overnight travel may be involved • This position is not eligible for sponsorship now or in the future • 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 • 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 others • Ability to handle confidential or sensitive information with discretion • Microsoft Office proficiency • Active LPN or LVN licensure in state hired, or active compact multistate LPN license under the Nurse Licensure Compact • Active RN licensure in state hired, or active compact multistate RN license under the Nurse Licensure Compact • 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 • 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