Senior Provider Education Consultant – IRF RCD

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🏈 Alabama, Tennessee – Remote

🏈 Alabama – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟠 Senior

💼 Consultant

👻 Ghost score 10%

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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 all provider contacts and communications in the provider tracking system • Conduct formal conference calls and/or in-person educational visits with providers who consistently overutilize services, are under progressive corrective action, or have unacceptable denial/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 are overutilizing services and which services are being overutilized • 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 • Work an 8-hour shift during normal business hours of 8 a.m.–5 p.m.

🎯 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) • Must reside in Alabama, Georgia, or Tennessee • Must be able to travel up to 3-5 days a week, including possible weekday and weekend overnight travel • Position is not eligible for sponsorship now or in the future • Preferred: 3 years of provider relations and Medicare experience • Preferred: Knowledge of claims processing software and 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