Provides education to medical providers as warranted. Logistics: Location: This is a full-time remote position . You will work an 8-hour shift scheduled during our normal business hours of 8 a.m. – Must be able to travel up to 3-5 days a week. There may be some weekday and weekend overnight traveling involved. May include travel outside of the assigned areas of Alabama, Georgia, or Tennessee as necessary. 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 all provider contacts/communications in provider tracking system. Conducts 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. Researches, composes, and coordinates the preparation of all regulatory based provider education materials. Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits. Works with medical review department and provides input regarding actions taken in response to provider billing practices. 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. 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 Work Experience: - If LPN or LVN, 7 years of clinical experience or equivalent combination of clinical and educator experience. - Knowledge of medical terminology and disease processes. Demonstrated proficiency in word processing and spreadsheet software. Effective customer service, organizational, and presentation skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Preferred Work Experience: 3 years of provider relations and Medicare experience. IRF (Inpatient Rehabilitation Facility) education consultant experience. Knowledge of claims processing software. Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software. Subsidized health plans, dental and vision coverage
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