Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.
Description
Logistics:
- Communicate and 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 and communications in the 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 reviews / audits.
- Determine what providers are over-utilizing services and what services are being over-utilized.
- Work with the medical review department and provide 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 enter reviewer reliability (IRR) studies.
- Assist in training of medical review associates regarding coverage and medical review processes.
- May involve travel between office buildings or traveling to and from provider locations.
- May involve travel outside of the state.
To Qualify for This Position, You’ll Need:
- An active LPN or LVN license in the state hired OR an active compact multistate LPN license and seven years of clinical experience OR equivalent combination of clinical and educator experience.
- An active RN license in the state hired OR an active compact multistate RN license and five 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.
- 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.
- In-depth knowledge of Medicare program instructions / regulations related to provider enrollment issues.
- Microsoft Office.
- Three 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.
- 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.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.