Sr. Provider Education Consultant; LPN, LVN, RN

Position: Sr. Provider Education Consultant (LPN, LVN, RN)
## Sr. Provider Education Consultant (LPN, LVN, RN)
Apply:
Remote:
W@H South Carolina:
Full time:
Posted Today:
End Date:
November 30, 2026 (18 days left to apply):
R1053103#
** Summary
* * Provides education to medical providers as warranted.#
** Description
* * Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts.

We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
** Position

Purpose:

** The Sr. Provider Education Consultant will be responsible for communicating with healthcare providers about the TPE (Targeted Probe and Educate) process, supporting medical review activities, developing educational materials, and helping providers understand and comply with Medicare requirements.  They will contact physicians, hospitals, clinics, or other healthcare providers when they have been selected for a TPE review, explaining why they were selected, and provide guidance on documentation requirements and next steps.

** Logistics:
** Palmetto GBA– one of Blue Cross Blue Shield's South Carolina subsidiary companies.
*
* Location:

This a full-time remote position**. You will work an 8-hour shift scheduled during our normal business hours of 8:30 a.m. – 5 p.m. EST.
** Sponsorship**:
This position is not eligible for sponsorship now or in the future.
*
* What You’ll Do:

*
* * Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts.
* Documents all provider contacts/communications in provider tracking system.
* Conducts 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.
* Conducts coverage and documentation workshops for provider staff (Medicare providers and physicians' staff).
* Researches, composes, and coordinates the preparation of all regulatory based provider education materials.
* Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits.
* Determines what providers are over-utilizing services and what services are being over-utilized.
* Works with medical review department and provides input regarding actions taken in response to provider billing practices.
* Targets providers where greatest abuse of Medicare program has occurred.
* Participates in the medical review process and inter reviewer reliability (IRR) studies.
* Assists in training of medical review associates regarding coverage and medical review process.
** To Qualify for This Position, You’ll Need the Following:
**** Required

Education:

*** 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.
** Required

Work Experience:

*** 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.
** Required

Skills and…