Senior Provider Education Consultant, LPN, LVN, RN

Palmetto GBA

. Communicate and educate healthcare providers on Medicare coverage, utilization statistics, documentation, and medical review through advisories, reports, letters, and telephone contacts .

Posted 11/11/2026full-timeRemote • South Carolina • 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 overutilization and compliance. Proficient in communication and training, ensuring effective collaboration with healthcare providers and adherence to regulatory standards.

Highest-signal resume keywords

Active LPN Or LVN LicensureActive RN LicensureMedicare ExperienceKnowledge Of Medical TerminologyProficiency In Microsoft Office

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ExperienceAnalytical SkillsDocumentation SkillsPresentation SkillsBusiness Math ProficiencyKnowledge Of Claims Processing SoftwareKnowledge Of Statistical ConceptsResearch SkillsProvider EducationMedical Review Process

Soft Skills

Good Judgment SkillsCustomer Service SkillsOrganizational SkillsAbility To PersuadeAbility To Handle Confidential Information

Tools & Technologies

Word Processing SoftwareSpreadsheet SoftwareMicrosoft ExcelDatabase Software

Certifications & Qualifications

LPN LicenseLVN LicenseRN License

Industry Keywords

Medicare ProgramUtilization StatisticsDocumentation WorkshopsProvider Tracking SystemMedical Review Department

About the role

Key responsibilities & impact

Communicate and educate healthcare providers on Medicare coverage, utilization statistics, documentation, and medical review through advisories, reports, letters, and telephone contacts
Document all provider communications in the provider tracking system
Conduct 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 provider staff 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
Collaborate with the medical review department and provide input on actions related to provider billing practices
Target providers where the greatest Medicare program abuse has occurred
Participate in the medical review process and inter-reviewer reliability studies
Assist in training medical review associates on coverage and medical review processes

Requirements

What you’ll need

LPN: graduate of accredited School of Licensed Practical Nursing; LVN: graduate of accredited School of Licensed Vocational Nursing; RN: graduate of 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
Proficiency in word processing and spreadsheet software
Good judgment skills
Customer service, organizational, and presentation skills
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/LVN license under the Nurse Licensure Compact
Active RN licensure in state hired, or active compact multistate RN license under the Nurse Licensure Compact
No sponsorship eligibility now or in the future
Medicare experience preferred
Knowledge of claims processing software preferred
In-depth knowledge of Medicare program, guidelines, and coverage regulations preferred
Working knowledge of Microsoft Excel or other database software preferred

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, advance careers and contribute to company growth
Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs