Summary
 

As a Sr. Provider Education Consultant, you will be responsible for providing education to medical providers.

Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics:

This is a Work at Home (W@H) position.  The hours are 8:00 a.m. – 5:00 p.m. Monday – Friday.

What You’ll Do:

• Communicate / educate providers on issues such as Medicare coverage, utilization statistics, documentation, and medical review by use of written advisories, reports, letters, and telephone contacts.
• Document all provider contacts / communications in provider tracking system.
• Conduct 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.
• Conduct coverage and documentation workshops for provider staff (Medicare providers and physicians' staff).
• Research, compose, and coordinate the preparation of all regulatory based provider education materials.
• Perform analysis of effective reports to determine actions to be taken regarding medical reviewed its / audits.
• Determine what providers are over-utilizing services and what services are being over-utilized.
• Work with medical review department and provides input regarding actions taken in response to provider billing practices.
• Target providers where greatest abuse of Medicare program has occurred.
• Participate in the medical review process and inter reviewer reliability (IRR) studies.
• Assist in training of medical review associates regarding coverage and medical review process.

To Qualify for This Position, You’ll Need:

Required Education:

• Other Degree - 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.
• LPN or LVN, seven years of clinical experience or equivalent combination of clinical and educator experience.
• RN five years of clinical experience or equivalent combination of clinical and educator experience.

Required Licenses and Certificates:

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

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.
• De