Senior Provider Education Consultant - IRF RCD
## Senior Provider Education Consultant - IRF RCD at Palmetto GBA Palmetto GBA, a Blue. Cross Blue. Shield of South Carolina subsidiary, is seeking a Senior Provider Education Consultant to join our team. This role focuses on educating medical providers on Medicare coverage, documentation, and billing practices. **Location & Schedule:** This is a full-time remote position. You must reside in Alabama, Georgia, or Tennessee. You'll work an 8-hour shift during normal business hours (8 a.m. – 5 p.m.). Travel is required up to 3-5 days per week, including some weekday and weekend overnight travel, and may include travel outside your assigned state as necessary. **What You'll Be Doing:** You will communicate with providers on issues like Medicare coverage, utilization statistics, and medical review via written advisories, reports, letters, and phone calls. You'll document all provider contacts in our tracking system, conduct formal conference calls or in-person visits with providers who are over-utilizing services or have high denial/error rates, and lead coverage and documentation workshops for provider staff. Additionally, you'll research and prepare regulatory-based education materials, analyze reports to identify over-utilization trends, collaborate with the medical review department, and participate in inter-reviewer reliability studies. You may also assist in training medical review associates. **Qualifications We Require:** Education: If you are an LPN, you must be a graduate of an accredited School of Licensed Practical Nursing; if LVN, graduate of an accredited School of Licensed Vocational Nursing; if RN, graduate of an approved School of Nursing. Experience: For LPN or LVN, 7 years of clinical experience or equivalent combination of clinical and educator experience; for RN, 5 years. You need an active LPN, LVN, or RN license in your state (or compact multistate license). Skills: Knowledge of medical terminology and disease processes, proficiency in word processing and spreadsheet software (Microsoft Office), good judgment, effective customer service and presentation skills, strong analytical and critical thinking, basic business math, and the ability to handle confidential information. You should be persuasive and able to influence others. **Preferred Qualifications:** We prefer candidates with 3 years of provider relations and Medicare experience, especially IRF (Inpatient Rehabilitation Facility) education consulting. Knowledge of claims processing software and in-depth understanding of Medicare guidelines are a plus. Working knowledge of Microsoft Access or other database software is preferred. **Why Work With Us?** We offer a comprehensive benefits package starting the first of the month following 28 days of employment: subsidized health plans, dental and vision, 401k with company match, life insurance, paid time off, education assistance, service recognition, and national discounts. We are committed to diversity and inclusion and provide reasonable accommodations for disabilities, pregnancy, and religious beliefs. This position is not eligible for sponsorship. If you meet the qualifications, apply today and our recruiting team will reach out. --- _This job was found on [bandana.com](https://www.bandana.com/?utm_source=jd_attribution&utm_medium=repost)_
