Senior Provider Education Consultant, LPN, LVN, RN

Job not on LinkedIn

🔥 13 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – 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 healthcare providers on Medicare coverage, utilization statistics, documentation, and medical review through advisories, reports, letters, and telephone contacts • Document all provider communications in the provider tracking system • Conduct conference calls and/or in-person educational visits with providers involved in overutilization, progressive corrective action, or unacceptable denial/error rates • Conduct coverage and documentation workshops for Medicare provider staff 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 being over-utilized • Collaborate with the medical review department and provide input on actions related to provider billing practices • Target providers where the greatest Medicare program abuse 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

🎯 Requirements

• LPN: graduate of accredited School of Licensed Practical Nursing; LVN: graduate of accredited School of Licensed Vocational Nursing; RN: graduate of approved School of Nursing • LPN or LVN: 7 years of clinical experience or equivalent combination of clinical and educator experience • 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 state hired, or active compact multistate LPN/LVN license under the Nurse Licensure Compact • Active RN licensure in state hired, or active compact multistate RN license under the Nurse Licensure Compact • No sponsorship eligibility now or in the future • Medicare experience preferred • Knowledge of claims processing software preferred • In-depth knowledge of Medicare program, guidelines, and coverage regulations preferred • Working knowledge of Microsoft Excel or other database software preferred

🏖️ 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

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