Senior Provider Education Consultant, LPN, LVN, RN

🔥 12 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟠 Senior

💼 Consultant

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

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• No salary listed.

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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

• Communicate and educate providers about Medicare coverage, utilization statistics, documentation, and medical review through 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 involved in overutilization, progressive corrective action, or 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 reports to determine actions regarding medical reviews and audits • Determine which providers and services are being over-utilized • Work with the medical review department and provide input on actions responding 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 on coverage and medical review processes • Contact physicians, hospitals, clinics, and other healthcare providers selected for TPE review; explain selection, documentation requirements, and next steps

🎯 Requirements

• LPN: graduate of an accredited School of Licensed Practical Nursing • LVN: graduate of an accredited School of Licensed Vocational Nursing • RN: graduate of an 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 • 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 proficiency • Active LPN or LVN licensure in state hired, or active compact multistate LPN license under the Nurse Licensure Compact (NLC) • Active RN licensure in state hired, or active compact multistate RN license under the Nurse Licensure Compact (NLC) • Medicare experience preferred • Knowledge of claims processing software preferred • In-depth knowledge of Medicare programs, guidelines, and coverage regulations preferred • Working knowledge of Microsoft Excel or other database software preferred • Must not require 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 and advance careers • Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs

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