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

🔥 7 minutes ago

🇺🇸 United States – 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

• Communicates and educates providers on Medicare coverage, utilization statistics, documentation, and medical review through written advisories, reports, letters, and telephone contacts • Documents all provider contacts and communications in the provider tracking system • Conducts formal conference calls and/or in-person educational visits with providers who over-utilize services, are on progressive corrective action, or have unacceptable denial or error rates • Conducts coverage and documentation workshops for Medicare providers and physicians' staff • Researches, composes, and coordinates regulatory-based provider education materials • Analyzes reports to determine actions regarding medical reviews and audits • Determines which providers and services are over-utilizing services • Works with the medical review department and provides input on actions taken in response to provider billing practices • Targets providers where the greatest abuse of the Medicare program has occurred • Participates in the medical review process and inter-reviewer reliability studies • Assists in training medical review associates on coverage and the medical review process

🎯 Requirements

• Graduate of an accredited School of Licensed Practical Nursing if LPN, accredited School of Licensed Vocational Nursing if LVN, or approved School of Nursing if RN • 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, 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 • 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 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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