Provider Education & Consultation Consultant – LPN, LVN, RN

🔥 6 hours ago

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

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

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 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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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

BlueCross BlueShield of South Carolina is a leading health insurance provider that offers a variety of health plans, including individual and family plans, Medicare options, and group health plans. The organization focuses on providing coverage and resources for members, employers, and healthcare providers, ensuring access to quality healthcare services. With a commitment to promoting healthier lifestyles and supporting community health, BlueCross BlueShield of South Carolina plays a vital role in the healthcare landscape of the region.

📋 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 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 being overutilized • Work with the medical review department and provide input on responses 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 • Work an 8-hour shift during 8:00 a.m.–5:00 p.m. Monday–Friday business hours • Travel occasionally for in-person conferences and presentations; work occasional overtime as needed

🎯 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 • 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 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 • 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 and in-depth knowledge of Medicare programs, guidelines, and coverage regulations • 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