Prov Outreach Ed Rep

* Position is Eligible for Remote / Work from Home Opportunity*

Department:
Provider Education

Telecommuting Eligible:
Yes

Job Grade: N14

As a condition of employment, physical work location must be in one of the 50 states or the District of Columbia.

Notice of Collection & Privacy Policy for Applicants Residing in California:
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Provider Outreach and Education Representative I

The Provider Outreach and Education (POE) Representative is responsible for delivering Federal and State-aligned, data-driven education to providers and suppliers to reduce error rates, repeat provider inquiries, and claim submission errors. The role develops compliant education materials, analyzing operational data to identify risk and error trends, and coordinating education activities across internal and external stakeholders to improve provider understanding and reduce operational burden.

• Educates and facilitates provider education through webinars, teleconferences, in-person meetings, and work groups as a subject matter expert aligned with Federal and State priorities to reduce repeat provider inquiries, claims errors, and error rate findings.
• Possesses strong communication and organizational skills to successfully deliver education to executive level stakeholders such as internal individuals, Customer officials, and Associations related to new programs or changes within current program policies.
• Builds relationships with subject matter experts within various divisions of Federal and State to support new and existing programs.
• Follows established quality standards for education documentation and assists with corrections or updates as needed to ensure continued Federal and State compliance.
• Analyzes data and tracks trends in claims errors, error rate findings, medical review referrals, and provider inquiries to develop targeted education.
• Assists in monitoring post education trends to evaluate the impact of education on provider inquiries, claims errors, and error rate findings.
• Maintains current and extensive knowledge of Federal and State rules, regulations, processing guidelines, and Internet-Only Manuals (IOM).
• Creates and maintains Federal and State
  -compliant, Section 508 accessible education materials and web content.
• Coordinates with internal departments to support operational improvement and reduce repeat work through education.
• Serves as a professional subject matter expert in Federal and State
  -mandated meetings and provider forums.
• Participates in aligning education activities to Federal and State identified risk areas and assists with tracking education focus areas based on inquiry trends, error rate data, and medical review referrals.
• Documents education activities accurately and timely in Federal and State
  -required systems.
• Supports Federal and State
  -mandated POE activities including Advisory Groups, ACTs, and reporting requirements.
• Identifies process improvement opportunities and communicates recommendations to management.
• Ensures confidentiality, security, ISO, and Federal and State compliance requirements are met.

• Participates in pilot initiatives, special projects, and work groups.
• Provides backup support during periods of increased workload.
• Performs other related duties consistent with position scope.
• Other duties as assigned.

• Associate's degree in Healthcare Administration, Health Information Management, Public Health, Business, Communications, Education, or related field; or equivalent combination of education and experience may be considered including Federal, and State or Medicare experience as determined by Human Resources
• 2 years Medicare experience
• Strong analytical and communication skills
• Experience applying Medicare policy, regulations or processing guidelines

Above requirements and the following:

• 4 years' Medicare experience
• Provider education or public speaking experience

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone usage
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent stooping
• Infrequent lifting up to 15 pounds
• Travel required

Every employee is responsible to perform their duties and…