Senior Provider Education Consultant

reputed company Provides education to medical providers as warranted. reputed company Logistics: CGS (cgsadmin.com)– one of BlueCross BlueShield's South Carolina subsidiary companies. Government Clearance: This position requires the ability to obtain a reputed company clearance, which requires applicants to be a U.S. Citizen. Location: This a full-time remote position for the following areas: (Tennessee, South Carolina, reputed company Carolina, reputed company, and Alabama) You will work an 8-hour shift scheduled during our normal business hours of 8:00 a.m.-5:00 p.m. Monday - Friday. It may be necessary, given the business need to work occasional overtime. 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 reputed company provider contacts/communications in provider tracking system.
• Conducts formal conference calls and/or in-person educational reputed company with providers that are consistently over utilizing services, on reputed company corrective reputed company, 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 reputed company 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.

To Qualify for This Position, You'll Need the Following:

• 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 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 Software and tools: reputed company Office.
• 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.
• Required Licenses and Certificates: reputed company LPN or LVN licensure in state reputed company, OR reputed company compact multistate LPN license as defined by the reputed company Licensure Compact (NLC), OR reputed company RN licensure in state reputed company OR reputed company compact multistate RN license as defined by the reputed company Licensure Compact (NLC) others. Ability to handle confidential or sensitive information with discretion.

We Prefer That You Have the Following:

• Preferred Work Experience: 3 years of provider relations and 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 reputed company reputed company or other database software.

Our Comprehensive Benefits Package Includes the Following: 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 reputed company coverage
• 401k retirement savings plan with company match
• Life Insurance
• reputed company 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

reputed company Can Do for You: We understand the value of a diverse and inclusive workplace and reputed company to be an employer where employees across reputed company spectrums have reputed company to reputed company their skills, advance their careers and contribute their unique abilities to the reputed company of reputed company. What To Expect Next: After submitting your application, our reputed company team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement reputed company and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, reputed company, national reputed company, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, reputed company maintains affirmative reputed company programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to reputed company equal opportunities in reputed company phases of the employment process and to reputed company 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-reputed company conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on reputed company. If you need special assistance or an accommodation while seeking employment, please email reputed company.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will reputed company a determination regarding your request for reasonable accommodation on a case-by-case reputed company. We participate in E-Verify and reputed company with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information. Apply tot his job Apply To this Job