WPS—A health solutions company
Clinical Medicare Outreach and Education Specialist (HH & H)
WPS—A health solutions company, Madison, Wisconsin, us, 53774
Overview
Clinical Medicare Outreach and Education Specialist (HH & H) plays a crucial role in our Medicare Program by developing and delivering educational content to the provider community regarding current and upcoming CMS regulations. This role creates educational materials, hosts events, and analyzes data to improve provider education and reduce billing errors in a fast-paced remote environment. The education is provided to Medicare providers such as physicians, non-physician practitioners, nurses, therapists, coders, billers, and compliance staff to help them understand the Medicare program and be informed about changes. The role supports providers in developing best practices to avoid coverage and billing errors to reduce error rates and protect the Medicare Trust Fund. The Outreach and Education Specialist focuses on ensuring a positive customer experience through relationship building with providers, CMS, and other stakeholders. Salary Range : $61,000 ~ $95,000 Work Location : Remote work in approved states: Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
Responsibilities
Develop and deliver educational materials and presentations on current CMS regulations for Medicare providers.
Host events and training sessions tailored to provider needs.
Analyze error data, geographical data, and Medicare regulations to identify education gaps and areas for improvement.
Reduce billing and coverage errors to protect the Medicare Trust Fund.
Build and maintain positive relationships with providers, CMS, and other stakeholders to ensure a positive customer experience.
Collaborate with clinical and administrative teams to understand provider challenges and develop targeted solutions.
Serve as a resource on updates in guidelines, policies, documentation, and regulatory requirements.
Coordinate with internal teams (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate identified issues to POE staff.
Establish and maintain a POE Advisory Group to assist contractors in education strategy development and review.
Qualifications
Minimum Qualifications Bachelor’s Degree in Communications, Health Education, Nursing or related field, or equivalent education/experience. 2+ years as a Medical Review Nurse Analyst with Medicare knowledge. 3+ years in a role supporting Medicare. 1+ years in Medicare communications. Experience developing educational materials and presentations. Knowledge of Medicare Part A/B and Home Health & Hospice guidelines. Solid knowledge of medical billing, coding, and insurance processes. Proficiency with Microsoft Office and training delivery tools. Strong written and verbal communication skills. Ability to travel ~15%.
Preferred Qualifications 4+ years of clinical nursing experience. CMS knowledge of Home Health and Hospice. Strong facilitation and training experience with large groups. Experience processing Home Health and Hospice appeals. MAC contractor experience with FISS, MCS, and MAS systems.
Remote Work Requirements
Wired internet connection (ethernet) from router to computer
High-speed cable or fiber internet
Minimum 10 Mbps download and 1 Mbps upload
Review Remote Worker FAQs for additional information
Benefits
Remote and hybrid work options
Performance bonus and/or merit increase opportunities
401(k) with generous employer match
Competitive paid time off
Health, dental, and telehealth services from Day 1
Professional and Leadership Development Programs
See full benefits: https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml
About Us WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We provide health plans and manage Medicare beneficiaries and military personnel benefits for millions of individuals. We are proud to be military and veteran ready.
#J-18808-Ljbffr
Clinical Medicare Outreach and Education Specialist (HH & H) plays a crucial role in our Medicare Program by developing and delivering educational content to the provider community regarding current and upcoming CMS regulations. This role creates educational materials, hosts events, and analyzes data to improve provider education and reduce billing errors in a fast-paced remote environment. The education is provided to Medicare providers such as physicians, non-physician practitioners, nurses, therapists, coders, billers, and compliance staff to help them understand the Medicare program and be informed about changes. The role supports providers in developing best practices to avoid coverage and billing errors to reduce error rates and protect the Medicare Trust Fund. The Outreach and Education Specialist focuses on ensuring a positive customer experience through relationship building with providers, CMS, and other stakeholders. Salary Range : $61,000 ~ $95,000 Work Location : Remote work in approved states: Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
Responsibilities
Develop and deliver educational materials and presentations on current CMS regulations for Medicare providers.
Host events and training sessions tailored to provider needs.
Analyze error data, geographical data, and Medicare regulations to identify education gaps and areas for improvement.
Reduce billing and coverage errors to protect the Medicare Trust Fund.
Build and maintain positive relationships with providers, CMS, and other stakeholders to ensure a positive customer experience.
Collaborate with clinical and administrative teams to understand provider challenges and develop targeted solutions.
Serve as a resource on updates in guidelines, policies, documentation, and regulatory requirements.
Coordinate with internal teams (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate identified issues to POE staff.
Establish and maintain a POE Advisory Group to assist contractors in education strategy development and review.
Qualifications
Minimum Qualifications Bachelor’s Degree in Communications, Health Education, Nursing or related field, or equivalent education/experience. 2+ years as a Medical Review Nurse Analyst with Medicare knowledge. 3+ years in a role supporting Medicare. 1+ years in Medicare communications. Experience developing educational materials and presentations. Knowledge of Medicare Part A/B and Home Health & Hospice guidelines. Solid knowledge of medical billing, coding, and insurance processes. Proficiency with Microsoft Office and training delivery tools. Strong written and verbal communication skills. Ability to travel ~15%.
Preferred Qualifications 4+ years of clinical nursing experience. CMS knowledge of Home Health and Hospice. Strong facilitation and training experience with large groups. Experience processing Home Health and Hospice appeals. MAC contractor experience with FISS, MCS, and MAS systems.
Remote Work Requirements
Wired internet connection (ethernet) from router to computer
High-speed cable or fiber internet
Minimum 10 Mbps download and 1 Mbps upload
Review Remote Worker FAQs for additional information
Benefits
Remote and hybrid work options
Performance bonus and/or merit increase opportunities
401(k) with generous employer match
Competitive paid time off
Health, dental, and telehealth services from Day 1
Professional and Leadership Development Programs
See full benefits: https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml
About Us WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We provide health plans and manage Medicare beneficiaries and military personnel benefits for millions of individuals. We are proud to be military and veteran ready.
#J-18808-Ljbffr