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

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🔥 21 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

💼 Consultant

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• 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/or in-person educational visits with providers who overutilize 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 reports to determine actions regarding medical reviews and audits • Determine which providers and services are overutilized • Work with the medical review department and provide input on actions related to provider billing practices • Target providers associated with the greatest abuse of the Medicare program • Participate in the medical review process and inter-reviewer reliability (IRR) studies • Assist in training medical review associates on coverage and medical review processes • May travel between office buildings, to and from provider locations, and within or outside the state

🎯 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 • 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 • 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) • South Carolina, North Carolina, Georgia, or Alabama work location eligibility • 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 Excel, Microsoft Access, or other database software preferred • 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 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

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