Sr. Provider Education Consultant

Summary
 As a Sr. Provider Education Consultant, you will provide 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 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 position 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. Documents 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.
• Conducts 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:

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

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.

Skills:

• 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.
• Experience with Microsoft Office.

Licenses:

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

What We Prefer:

• 3 years-of provider relations and Medicare experience.
• Knowledge of claims processing software.
• In-depth knowledge of Medicare program, guidelines, regulations governing coverage.
• Working knowledge of Microsoft Access or other database software.

Work Environment:

Typical office environment may involve travel between office buildings may involve travel to/from provider locations may involve travel within/outside of state.

What We can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.