Senior Provider Education Consultant – IRF RCD

Jobtailor; Deutschland; Hybrid; EUR 55.000 - 75.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a qualified educator to improve Medicare provider education, focusing on coverage, documentation, and medical reviews. You will conduct formal educational visits, produce advisories and letters, and document communications in the provider tracking system.

The role requires licensure in nursing and significant clinical experience, plus proficiency with Microsoft Office and claims software, to support regulatory compliance and provider education initiatives.

Qualifikationen

• Active RN license in the state hired or compact multistate license.
• Active LPN or LVN licensure in the state hired or compact multistate license.
• 5 years of clinical experience for RN or 7 years for LPN/LVN combined with educator experience.
• Knowledge of medical terminology and disease processes.
• Proficient in word processing and spreadsheet software.

Aufgaben

• Provide education to medical providers on Medicare coverage and utilization statistics.
• Communicate and educate providers through advisories, reports, letters, and calls.
• Document provider contacts in the provider tracking system.
• Conduct educational visits with providers who overutilize services or have high denial rates.
• Research and coordinate regulatory-based provider education materials.

Kenntnisse

Medical Terminology Knowledge

Analytical Skills

Presentation Skills

Documentation Skills

Business Math Proficiency

Ausbildung

RN License

LPN License

LPN/LVN Licensure

Tools

Microsoft Office

Claims Processing Software

Microsoft Access

Provider Tracking System

Jobbeschreibung

• 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/or in-person educational visits with providers who overutilize services, are under 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 effective reports to determine actions regarding medical reviews and audits


• Determine which providers and services are overutilizing resources


• 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

Requirements

• Must reside in Alabama, Georgia, or Tennessee


• Must be able to travel up to 3-5 days a week


• Weekday and weekend overnight travel may be involved


• This position is not eligible for sponsorship now or in the future


• 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 proficiency


• Active LPN or LVN licensure in state hired, or 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


• Preferred: 3 years of provider relations and 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 Access or other database software

Core Competencies

Demonstrates expertise in provider education and communication regarding Medicare coverage and documentation, with strong analytical skills to assess provider performance and compliance. Proficient in utilizing Microsoft Office and claims processing software to support educational initiatives and regulatory compliance.

Highest-signal resume keywords

• Active RN Licensure


• Active LPN Licensure


• Medicare Program Knowledge


• Provider Relations Experience


• Clinical Experience

Hard Skills

• Medical Terminology Knowledge


• Analytical Skills


• Presentation Skills


• Documentation Skills


• Business Math Proficiency

Soft Skills

• Effective Customer Service


• Good Judgment Skills


• Organizational Skills


• Persuasion Skills


• Critical Thinking Skills

Certifications & Qualifications

• Active Compact Multistate RN License


• Active Compact Multistate LPN License

Industry Keywords

• Medicare Coverage


• Utilization Statistics


• Medical Review Process


• Regulatory Compliance


• Provider Education

Tools & Technologies

• Microsoft Office


• Claims Processing Software


• Microsoft Access


• Provider Tracking System