Sr. Provider Education Consultant (LPN, LVN, RN)

033 Palmetto GBA; South Carolina; Hybride; USD 70 000 - 90 000; Plein temps

Avantages offerts par ce poste

Health plans

401k

PTO

Education assistance

Résumé du poste

BlueCross BlueShield of South Carolina seeks a Sr. Provider Education Consultant to educate providers on Medicare coverage and documentation while supporting medical review activities. You will create educational materials, coordinate workshops, and track communications with providers.

This full-time remote role requires experience in education, healthcare, and regulatory guidelines. Sponsorship is not available. The position is based in South Carolina with EST business hours.

Qualifications

• Knowledge of medical terminology and disease processes.
• Proficiency in word processing and spreadsheet software.
• Effective customer service, organizational, and presentation skills.

Responsabilités

• Educates providers on Medicare coverage, documentation, and medical review.
• Documents all provider contacts in tracking system.
• Conducts workshops for provider staff on coverage and documentation.

Connaissances

Medical terminology

Word processing

Spreadsheets

Customer service

Presentation skills

Analytical thinking

Formation

LPN or LVN licensure

RN license

Outils

Microsoft Office

Microsoft Excel

Description du poste

Summary

Provides education to medical providers as warranted.

Description

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose

The Sr. Provider Education Consultant will be responsible for communicating with healthcare providers about the TPE (Targeted Probe and Educate) process, supporting medical review activities, developing educational materials, and helping providers understand and comply with Medicare requirements. They will contact physicians, hospitals, clinics, or other healthcare providers when they have been selected for a TPE review, explaining why they were selected, and provide guidance on documentation requirements and next steps.

Logistics

Palmetto GBA– one of BlueCross BlueShield's South Carolina subsidiary companies.

This a full-time remote position. You will work an 8-hour shift scheduled during our normal business hours of 8:30 a.m. – 5 p.m. EST.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You'll Do

• Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts.
• Documents all provider contacts/communications in provider tracking system.
• Conducts formal conference calls and/or in-person educational visits with providers that are consistently over utilizing services, on progressive corrective action, or have unacceptable denial rates and/or error rates under the medical review program.
• Conducts coverage and documentation workshops for provider staff (Medicare providers and physicians' staff).
• Researches, composes, and coordinates the preparation of all regulatory based provider education materials.
• Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits.
• Determines what providers are over-utilizing services and what services are being over-utilized.
• Works with medical review department and provides input regarding actions taken in response to provider billing practices.
• Targets providers where greatest abuse of Medicare program has occurred.
• Participates in the medical review process and inter reviewer reliability (IRR) studies.
• Assists in training of medical review associates regarding coverage and medical review process.

Required Education

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.

Required Work Experience

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.

Required Skills and Abilities

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.

Required Software and Tools

Microsoft Office.

Required Licenses and Certificates

Active LPN or LVN licensure in state hired, OR, active compact multistate LPN license as defined by the Nurse Licensure Compact (NLC), Active RN licensure in state hired OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

Preferred Work Experience

Medicare experience.

Preferred Skills and Abilities

Knowledge of claims processing software. In-depth knowledge of Medicare program, guidelines, regulations governing coverage.

Preferred Software and Other Tools

Working knowledge of Microsoft Excel or other database software.

Benefits

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Veterans Welcome!

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.