Senior Provider Education Consultant

<reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><h1><br><reputed company><reputed company><reputed company><u><b>reputed company</b></u></reputed company></reputed company></reputed company><br> </h1></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company>Provides education to medical providers as warranted.<reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><h1><br><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><b><u>reputed company</u></b></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company><br> </h1></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company><p><b>Logistics:</b> <a href="https://cgsadmin.com/" reputed company="_blank" rel="noopener noreferrer">CGS (cgsadmin.com)</a><b>– </b>one of BlueCross BlueShield's South Carolina subsidiary companies.</p><p></p><p><b><reputed company>Government Clearance: </reputed company></b>This position requires the ability to obtain a reputed company clearance, which requires applicants to be a U.S. Citizen.</p><p></p><p><b><reputed company>Location: This a full-time remote position for the following areas: (Tennessee, South Carolina, reputed company Carolina, reputed company, and Alabama) </reputed company></b>You will work an 8-hour shift scheduled during our normal business hours of <b><reputed company>8:00 a.m.-5:00 p.m. Monday - Friday</reputed company></b>.<b><reputed company> </reputed company></b>It may be necessary, given the business need to work occasional overtime.</p><p></p><p><b><reputed company>What You’ll Do: </reputed company></b> </p><ul><li><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">Communicates/educates</reputed company> providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts.</li><li>Documents reputed company provider <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">contacts/communications</reputed company> in provider tracking system.</li><li>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.</li><li>Conducts coverage and documentation workshops for provider staff (Medicare providers and physicians' staff).</li><li>Researches, composes, and coordinates the preparation of reputed company regulatory based provider education materials.</li><li>Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits.</li><li>Determines what providers are over-utilizing services and what services are being over-utilized.</li><li>Works with medical review department and provides input regarding actions taken in response to provider billing practices.</li><li>Targets providers where greatest abuse of Medicare program has occurred.</li><li>Participates in the medical review process and inter reviewer reliability (IRR) studies.</li><li>Assists in training of medical review associates regarding coverage and medical review process.</li></ul><p></p><p><b><reputed company>To Qualify for This Position, You'll Need the Following:</reputed company></b></p><ul><li><b><reputed company>Required Education:</reputed company></b> 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.</li><li><b><reputed company>Required Experience:</reputed company></b> 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.</li><li><b><reputed company>Required Software and tools: </reputed company></b>reputed company Office.</li><li><b><reputed company>Required Skills and Abilities:</reputed company></b> 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.</li><li><b><reputed company>Required Licenses and Certificates:</reputed company></b> reputed company LPN or LVN licensure in state reputed company, <b><reputed company>OR</reputed company></b> reputed company compact multistate LPN license as defined by the reputed company Licensure Compact (NLC), <b><reputed company>OR </reputed company></b>reputed company RN licensure in state reputed company <b><reputed company>OR</reputed company></b> 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.</li></ul><p></p><p><b><reputed company>We Prefer That You Have the Following: </reputed company></b></p><ul><li><b><reputed company>Preferred Work Experience</reputed company></b>: 3 years of provider relations and Medicare experience.</li><li><b><reputed company>Preferred Skills and Abilities: </reputed company></b>Knowledge of claims processing software. In-depth knowledge of Medicare program, guidelines, regulations governing coverage.</li><li><b><reputed company>Preferred Software and Other Tools:</reputed company></b> Working knowledge of reputed company reputed company or other database software.</li></ul><p></p><p><b><reputed company>Our Comprehensive Benefits Package Includes the Following:</reputed company></b></p><p>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 <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">employment.  </reputed company></p><ul><li>Subsidized health plans, dental and reputed company coverage</li><li>401k retirement savings plan with company match</li><li>Life Insurance</li><li>reputed company Time Off (PTO)</li><li>On-site cafeterias and fitness centers in major locations</li><li>Education Assistance</li><li>Service Recognition</li><li>National discounts to movies, theaters, zoos, theme parks and more</li></ul><p></p><p><b><reputed company>reputed company Can Do for You: </reputed company></b></p><p>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.</p><p></p><p><b><reputed company>What To Expect Next: </reputed company></b></p><p>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.</p><p><b><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company><reputed company>Equal Employment Opportunity Statement</reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></reputed company></b></p><p></p><p>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 <reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">disabilities and</reputed company> 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.</p><p></p><p>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.</p><p></p><p>If you need special assistance or an accommodation while seeking employment, please email <a href="mailto:reputed company.help@bcbssc.com" reputed company="_blank" rel="noopener noreferrer"><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">reputed company.help@bcbssc.com</reputed company></a> or reputed company 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.</p><p></p><p>We participate in E-Verify and reputed company with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's <a href="https://www.southcarolinablues.com/web/reputed company/resources/c4cb28a0-f717-4f26-8270-abae70243be7/Everify_EEO+2019.pdf?MOD=AJPERES&CVID=mKvY6R0" reputed company="_blank" rel="noopener noreferrer"><reputed company style="reputed company-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">more information</reputed company></a><a href="https://www.southcarolinablues.com/web/reputed company/resources/c4cb28a0-f717-4f26-8270-abae70243be7/Everify_EEO+2019.pdf?MOD=AJPERES&CVID=mKvY6R0" reputed company="_blank" rel="noopener noreferrer">.</a></p><p></p><p>Some states have required notifications. Here's <a href="https://www.southcarolinablues.com/web/reputed company/resources/cf014797-0b05-46c2-ab33-ec3a1bf9864a/California+Notice+to+Applicants_.pdf?MOD=AJPERES&CVID=oJErh8p" reputed company="_blank" rel="noopener noreferrer">more information</a>. </p>