Senior Consultant, Provider Education

Palmetto GBA

. Communicates and educates providers on Medicare coverage, utilization statistics, documentation, and medical review through written advisories, reports, letters, and telephone contacts .

Posted 10/7/2026full-timeRemote • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare coverage, documentation, and provider education, with strong analytical skills to assess medical reviews and audits. Proficient in communication and training, ensuring effective collaboration with healthcare providers to address service overutilization and compliance.

Highest-signal resume keywords

Medicare Program KnowledgeProvider EducationAnalytical SkillsEffective CommunicationClinical Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical TerminologyClaims ProcessingStatistical ConceptsWord ProcessingSpreadsheet SoftwareBusiness Math ProficiencyDocumentation SkillsPresentation SkillsCritical ThinkingNegotiation Skills

Soft Skills

Customer ServiceOrganizational SkillsJudgment SkillsDiscretion

Tools & Technologies

Microsoft OfficeMicrosoft ExcelMicrosoft AccessDatabase Software

Certifications & Qualifications

Active LPN LicensureActive LVN LicensureActive RN LicensureNurse Licensure Compact (NLC) License

Industry Keywords

Medicare CoverageUtilization StatisticsMedical ReviewProvider Tracking SystemOverutilizationCorrective ActionDenial RatesError RatesRegulatory ComplianceProvider Billing Practices

About the role

Key responsibilities & impact

Communicates and educates providers on Medicare coverage, utilization statistics, documentation, and medical review through written advisories, reports, letters, and telephone contacts
Documents provider contacts and communications in the provider tracking system
Conducts formal conference calls and in-person educational visits with providers with service overutilization, progressive corrective action, unacceptable denial rates, or error rates
Conducts coverage and documentation workshops for Medicare providers and physicians' staff
Researches, composes, and coordinates regulatory-based provider education materials
Analyzes reports to determine actions regarding medical reviews and audits
Determines which providers and services are being over-utilized
Works with the medical review department and provides input on responses to provider billing practices
Targets providers where the greatest abuse of the Medicare program has occurred
Participates in the medical review process and inter-reviewer reliability studies
Assists in training medical review associates on coverage and the medical review process
Works an 8-hour shift during normal business hours of 8:30 a.m. to 5 p.m.; travel to provider locations and within or outside the state may be involved

Requirements

What you’ll need

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
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
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
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)
Medicare experience preferred
Knowledge of claims processing software preferred
In-depth knowledge of Medicare program, guidelines, regulations governing coverage preferred
Working knowledge of Microsoft Excel, Microsoft Access, or other database software preferred
Sponsorship is not available 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.