WPS—A health solutions company
Clinical Medicare Outreach and Education Specialist (HH & H)
WPS—A health solutions company, Denver, Colorado, United States
Clinical Medicare Outreach and Education Specialist (HH & H)
Role Snapshot: Our Clinical Medicare Outreach & Education Specialist (HH & H - Home Health and Hospice) 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 specialist 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 assists 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.
Possess experience working with Medicare specifically in the Home Health and Hospice space.
Thrive in developing and maintaining positive relationships with healthcare providers, clinics, and medical staff.
Enjoy planning, developing, coordinating and delivering educational sessions, workshops, and training materials tailored to provider needs.
Can analyze error data, geographical data, track Medicare regulations, CMS policy guidelines, coverage issues, and stay informed on upcoming legislation to identify education needs.
Engage in outreach activities that increase provider engagement and awareness of organizational services, programs, and initiatives.
Collaborate with clinical and administrative teams to understand provider challenges and develop targeted solutions.
Serve as a resource for providers regarding updates in guidelines, policies, documentation and regulatory requirements.
Coordinate with internal teams (e.g., Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to ensure identified issues are communicated to POE staff.
Establish and maintain a POE Advisory Group to assist contractors in creating, implementing, and reviewing provider education strategies.
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+ years specifically in Medicare communications.
Demonstrated 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.
Proficient with Microsoft Office Suite and delivering training via various technologies (e.g., YouTube Channel, WebEx).
Excellent written and verbal communication skills; ability to present complex information clearly to diverse audiences.
Strong interpersonal and relationship-building skills.
Ability to travel for onsite training and education sessions – travel approximately 15% in the future.
Preferred Qualifications
4+ years of clinical nursing experience.
CMS knowledge of the Home Health and Hospice program.
Strong facilitation, presentation and training experience to 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 your router to your computer
High-speed cable or fiber internet
Minimum of 10 Mbps downstream and 1 Mbps upstream
Please review Remote Worker FAQs for additional information
Benefits
Remote and hybrid work options available
Performance bonus and/or merit increase opportunities
401(k) with generous matching
Competitive paid time off
Health/dental insurance and telehealth services start DAY 1
Professional and Leadership Development Programs
Who We Are
WPS is a not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We offer health insurance plans for individuals, families, seniors, and groups, process claims, and provide customer support for Medicare beneficiaries and military personnel. We have a long history of service and are veteran-ready.
Equal Opportunity
We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or veteran status.
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Possess experience working with Medicare specifically in the Home Health and Hospice space.
Thrive in developing and maintaining positive relationships with healthcare providers, clinics, and medical staff.
Enjoy planning, developing, coordinating and delivering educational sessions, workshops, and training materials tailored to provider needs.
Can analyze error data, geographical data, track Medicare regulations, CMS policy guidelines, coverage issues, and stay informed on upcoming legislation to identify education needs.
Engage in outreach activities that increase provider engagement and awareness of organizational services, programs, and initiatives.
Collaborate with clinical and administrative teams to understand provider challenges and develop targeted solutions.
Serve as a resource for providers regarding updates in guidelines, policies, documentation and regulatory requirements.
Coordinate with internal teams (e.g., Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to ensure identified issues are communicated to POE staff.
Establish and maintain a POE Advisory Group to assist contractors in creating, implementing, and reviewing provider education strategies.
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+ years specifically in Medicare communications.
Demonstrated 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.
Proficient with Microsoft Office Suite and delivering training via various technologies (e.g., YouTube Channel, WebEx).
Excellent written and verbal communication skills; ability to present complex information clearly to diverse audiences.
Strong interpersonal and relationship-building skills.
Ability to travel for onsite training and education sessions – travel approximately 15% in the future.
Preferred Qualifications
4+ years of clinical nursing experience.
CMS knowledge of the Home Health and Hospice program.
Strong facilitation, presentation and training experience to 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 your router to your computer
High-speed cable or fiber internet
Minimum of 10 Mbps downstream and 1 Mbps upstream
Please review Remote Worker FAQs for additional information
Benefits
Remote and hybrid work options available
Performance bonus and/or merit increase opportunities
401(k) with generous matching
Competitive paid time off
Health/dental insurance and telehealth services start DAY 1
Professional and Leadership Development Programs
Who We Are
WPS is a not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We offer health insurance plans for individuals, families, seniors, and groups, process claims, and provide customer support for Medicare beneficiaries and military personnel. We have a long history of service and are veteran-ready.
Equal Opportunity
We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or veteran status.
#J-18808-Ljbffr