WPS—A health solutions company
Clinical Medicare Outreach and Education Specialist (HH & H)
WPS—A health solutions company, Columbia, South Carolina, United States
Overview
Clinical Medicare Outreach and Education Specialist (HH & H) role at
WPS—A health solutions company . The specialist develops and delivers 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. 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 stay informed about changes. The Outreach and Education Specialist focuses on ensuring a positive customer experience through relationship building with providers, CMS, and other stakeholders. Responsibilities
Develop and deliver educational content on current and upcoming CMS regulations to the provider community. Create and develop educational materials, host events, and analyze data to improve provider education and reduce billing errors. Assist providers in developing best practices to avoid coverage and billing errors and protect the Medicare Trust Fund. Enhance provider relationships and ensure a positive customer experience with providers, CMS, and other stakeholders. Coordinate with internal teams (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate issues to the Provider Outreach & Education (POE) staff. Establish and maintain a POE Advisory Group (POE AG) to assist in creation, implementation, and review of provider education strategies and efforts. Minimum Qualifications
Bachelor’s Degree in Communications, Health Education, Nursing or related field, or equivalent combination of education and experience. 2+ years of experience as a Medical Review Nurse Analyst with background in Medicare principles and guidelines. 3+ years in a role supporting Medicare. 1+ year specifically in Medicare communications. Experience developing educational materials and presentations. Extensive knowledge of Medicare Part A, Part B and/or Home Health and Hospice program guidelines and POE processes. Solid knowledge of medical billing, coding, and insurance processes. Proficiency with Microsoft Office Suite and delivering training via various platforms (e.g., YouTube, WebEx). Excellent written and verbal communication skills and ability to present complex information clearly to diverse audiences. Strong interpersonal and relationship-building skills. Ability to travel for onsite training and education sessions (~15% travel). Preferred Qualifications
4+ years of clinical nursing experience. CMS knowledge of Home Health and Hospice programs. Strong facilitation, presentation, and training experience for large groups. Experience processing Home Health and Hospice appeals. MAC contractor experience with FISS, MCS and MAS systems. Remote Work Requirements
Wired (ethernet) internet connection from router to computer. High-speed cable or fiber internet. Minimum of 10 Mbps downstream and at least 1 Mbps upstream. Review Remote Worker FAQs for additional information. Benefits
Remote and hybrid work options available. Performance bonus and/or merit increase opportunities. 401(k) with employer match; fully vested. Competitive paid time off. Health, dental, and telehealth services start DAY 1. Professional and Leadership Development Programs. See full benefits at the company careers page. About Us
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We offer health plans for individuals, families, seniors, and groups, process claims, and provide customer support for Medicare beneficiaries and military personnel. WPS has a long history of serving the public and is proud to be military and veteran ready. Compliance
This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). The role is subject to applicable federal regulations, CMS contract requirements, and WPS policies, including data security, privacy, confidentiality, and program integrity. CMS contractors and personnel are subject to screening and background checks prior to access to information systems and sensitive data.
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Clinical Medicare Outreach and Education Specialist (HH & H) role at
WPS—A health solutions company . The specialist develops and delivers 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. 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 stay informed about changes. The Outreach and Education Specialist focuses on ensuring a positive customer experience through relationship building with providers, CMS, and other stakeholders. Responsibilities
Develop and deliver educational content on current and upcoming CMS regulations to the provider community. Create and develop educational materials, host events, and analyze data to improve provider education and reduce billing errors. Assist providers in developing best practices to avoid coverage and billing errors and protect the Medicare Trust Fund. Enhance provider relationships and ensure a positive customer experience with providers, CMS, and other stakeholders. Coordinate with internal teams (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate issues to the Provider Outreach & Education (POE) staff. Establish and maintain a POE Advisory Group (POE AG) to assist in creation, implementation, and review of provider education strategies and efforts. Minimum Qualifications
Bachelor’s Degree in Communications, Health Education, Nursing or related field, or equivalent combination of education and experience. 2+ years of experience as a Medical Review Nurse Analyst with background in Medicare principles and guidelines. 3+ years in a role supporting Medicare. 1+ year specifically in Medicare communications. Experience developing educational materials and presentations. Extensive knowledge of Medicare Part A, Part B and/or Home Health and Hospice program guidelines and POE processes. Solid knowledge of medical billing, coding, and insurance processes. Proficiency with Microsoft Office Suite and delivering training via various platforms (e.g., YouTube, WebEx). Excellent written and verbal communication skills and ability to present complex information clearly to diverse audiences. Strong interpersonal and relationship-building skills. Ability to travel for onsite training and education sessions (~15% travel). Preferred Qualifications
4+ years of clinical nursing experience. CMS knowledge of Home Health and Hospice programs. Strong facilitation, presentation, and training experience for large groups. Experience processing Home Health and Hospice appeals. MAC contractor experience with FISS, MCS and MAS systems. Remote Work Requirements
Wired (ethernet) internet connection from router to computer. High-speed cable or fiber internet. Minimum of 10 Mbps downstream and at least 1 Mbps upstream. Review Remote Worker FAQs for additional information. Benefits
Remote and hybrid work options available. Performance bonus and/or merit increase opportunities. 401(k) with employer match; fully vested. Competitive paid time off. Health, dental, and telehealth services start DAY 1. Professional and Leadership Development Programs. See full benefits at the company careers page. About Us
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We offer health plans for individuals, families, seniors, and groups, process claims, and provide customer support for Medicare beneficiaries and military personnel. WPS has a long history of serving the public and is proud to be military and veteran ready. Compliance
This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). The role is subject to applicable federal regulations, CMS contract requirements, and WPS policies, including data security, privacy, confidentiality, and program integrity. CMS contractors and personnel are subject to screening and background checks prior to access to information systems and sensitive data.
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