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Senior Provider Education Consultant, LPN, LVN, RN
BlueCross BlueShield of South Carolina. Communicate and educate providers about Medicare coverage, utilization statistics, documentation, and medical review through advisories, reports, letters, and telephone contacts .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare programs, coverage regulations, and provider education, with strong analytical skills to assess over-utilization and improve billing practices. Proficient in communication and training, ensuring effective collaboration with healthcare providers.
Highest-signal resume keywords
Active RN LicensureActive LPN LicensureMedicare ExperienceMedical Terminology KnowledgeClaims Processing Software Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ExperienceAnalytical SkillsBusiness Math ProficiencyDocumentation SkillsPresentation Skills
Soft Skills
Effective Customer ServiceGood Judgment SkillsOrganizational SkillsPersuasion SkillsNegotiation Skills
Tools & Technologies
Microsoft OfficeMicrosoft ExcelSpreadsheet SoftwareWord Processing SoftwareDatabase Software
Certifications & Qualifications
LPN LicenseLVN LicenseRN License
Industry Keywords
Medicare CoverageUtilization StatisticsMedical ReviewProvider EducationHealthcare Providers
About the role
Key responsibilities & impact- Communicate and educate providers about Medicare coverage, utilization statistics, documentation, and medical review through 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 involved in overutilization, progressive corrective action, or unacceptable denial/error rates
- Conduct coverage and documentation workshops for Medicare providers and physicians' staff
- Research, compose, and coordinate regulatory-based provider education materials
- Analyze reports to determine actions regarding medical reviews and audits
- Determine which providers and services are being over-utilized
- Work with the medical review department and provide input on actions responding to provider billing practices
- Target providers where the greatest abuse of the Medicare program has occurred
- Participate in the medical review process and inter-reviewer reliability (IRR) studies
- Assist in training medical review associates on coverage and medical review processes
- Contact physicians, hospitals, clinics, and other healthcare providers selected for TPE review; explain selection, documentation requirements, and next steps
Requirements
What you’ll need- LPN: graduate of an accredited School of Licensed Practical Nursing
- LVN: graduate of an accredited School of Licensed Vocational Nursing
- RN: graduate of an approved School of Nursing
- LPN or LVN: 7 years of clinical experience or equivalent combination of clinical and educator experience
- RN: 5 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
- Microsoft Office proficiency
- Active LPN or LVN licensure in state hired, or active compact multistate LPN license under the Nurse Licensure Compact (NLC)
- Active RN licensure in state hired, or active compact multistate RN license under the Nurse Licensure Compact (NLC)
- Medicare experience preferred
- Knowledge of claims processing software preferred
- In-depth knowledge of Medicare programs, guidelines, and coverage regulations preferred
- Working knowledge of Microsoft Excel or other database software preferred
- Must not require sponsorship now or in the future
Benefits
Comp & perks- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more.
- Diverse and inclusive workplace with opportunities to develop skills and advance careers
- Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs