Senior Provider Education Advisor – Remote

Southcarolinablues; Lexington, Northern (SC, KY); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off

Education Assistance

Job summary

Palmetto GBA, a BlueCross BlueShield subsidiary in South Carolina, seeks a Sr Provider Education specialist for a full-time remote role across multiple Southeastern states. You will educate providers on Medicare coverage, perform workshops, and prepare regulatory materials while documenting communications in the tracking system.

You will analyze utilization data, lead corrective actions for high-utilization providers, and support training for medical review staff.

Qualifications

• Must hold active LPN, LVN, or RN licensure in the state hired.
• LPN/LVN: 7 years clinical or educator experience; RN: 5 years.
• Knowledge of medical terminology and disease processes.
• Proficiency with word processing and spreadsheets; basic math.

Responsibilities

• Educate providers on Medicare coverage, utilization statistics, and medical review via advisories, reports, letters, and calls.
• Document all provider contacts in the provider tracking system.
• Lead conference calls or in-person visits with high-utilization providers for corrective action.
• Conduct workshops for provider staff on Medicare documentation.
• Prepare regulatory-based provider education materials.
• Analyze reports to determine actions regarding medical reviews and over-utilization.
• Assist in training of medical review staff and IRR studies.

Skills

Medical terminology

Analytical thinking

Presentation skills

Customer service

Spelling & grammar

Word processing

Discretion

Mathematical concepts

Education

Licensed Practical Nurse (LPN)

Licensed Vocational Nurse (LVN)

Registered Nurse (RN)

Tools

Microsoft Office

Job description

Palmetto GBA, a BlueCross BlueShield subsidiary in South Carolina, seeks a Sr Provider Education specialist for a full-time remote role across multiple Southeastern states. You will educate providers on Medicare coverage, perform workshops, and prepare regulatory materials while documenting communications in the tracking system.

You will analyze utilization data, lead corrective actions for high-utilization providers, and support training for medical review staff.