WPS—A health solutions company
Clinical Medicare Outreach and Education Specialist (HH & H)
WPS—A health solutions company, Lincoln, Nebraska, United States
Overview
Clinical Medicare Outreach and Education Specialist (HH & H) supports the Medicare Program by developing and delivering educational content to the provider community regarding CMS regulations. The specialist creates educational materials, hosts events, and analyzes data to improve provider education and reduce billing errors in a remote environment. Education is provided to Medicare providers (physicians, non-physician practitioners, nurses, therapists, coders, billers, compliance staff) to help them understand the Medicare program and stay informed about changes. The role focuses on fostering positive customer experiences through relationships with providers, CMS, and other stakeholders. Responsibilities
Develop and deliver educational materials and presentations on CMS regulations and Medicare guidelines. Host events, workshops, and training sessions tailored to provider needs. Analyze error data, geographical data, and update education strategies based on Medicare regulations and policy changes. Conduct outreach to 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 (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate identified issues to POE staff. Establish and maintain a POE Advisory Group (POE AG) 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 Medicare principles knowledge. 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. Proficient with Microsoft Office Suite and delivering training via various technologies (e.g., YouTube Channel, WebEx). Excellent written and verbal communication skills with the ability to present complex information to diverse audiences. Strong interpersonal and relationship-building skills. Ability to travel for onsite training and education sessions (approximately 15%). 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 internet connection from your router to your computer; high-speed cable or fiber preferred. Minimum of 10 Mbps downstream and at least 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 match Competitive paid time off Health, dental, and telehealth services start DAY 1 Professional and Leadership Development Programs Review additional benefits: https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml Who We Are
WPS, a health solutions company, is a not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We provide health plans, process claims, and support beneficiaries of the Medicare program and manage benefits for military personnel. WPS has been serving for nearly 80 years and is military and veteran ready. Note
This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). It is subject to applicable federal regulations, CMS contract requirements, and WPS policies, including data security and program integrity. CMS contractors and personnel are subject to screening and background investigations before access to information systems and sensitive data.
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Clinical Medicare Outreach and Education Specialist (HH & H) supports the Medicare Program by developing and delivering educational content to the provider community regarding CMS regulations. The specialist creates educational materials, hosts events, and analyzes data to improve provider education and reduce billing errors in a remote environment. Education is provided to Medicare providers (physicians, non-physician practitioners, nurses, therapists, coders, billers, compliance staff) to help them understand the Medicare program and stay informed about changes. The role focuses on fostering positive customer experiences through relationships with providers, CMS, and other stakeholders. Responsibilities
Develop and deliver educational materials and presentations on CMS regulations and Medicare guidelines. Host events, workshops, and training sessions tailored to provider needs. Analyze error data, geographical data, and update education strategies based on Medicare regulations and policy changes. Conduct outreach to 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 (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate identified issues to POE staff. Establish and maintain a POE Advisory Group (POE AG) 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 Medicare principles knowledge. 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. Proficient with Microsoft Office Suite and delivering training via various technologies (e.g., YouTube Channel, WebEx). Excellent written and verbal communication skills with the ability to present complex information to diverse audiences. Strong interpersonal and relationship-building skills. Ability to travel for onsite training and education sessions (approximately 15%). 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 internet connection from your router to your computer; high-speed cable or fiber preferred. Minimum of 10 Mbps downstream and at least 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 match Competitive paid time off Health, dental, and telehealth services start DAY 1 Professional and Leadership Development Programs Review additional benefits: https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml Who We Are
WPS, a health solutions company, is a not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. We provide health plans, process claims, and support beneficiaries of the Medicare program and manage benefits for military personnel. WPS has been serving for nearly 80 years and is military and veteran ready. Note
This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). It is subject to applicable federal regulations, CMS contract requirements, and WPS policies, including data security and program integrity. CMS contractors and personnel are subject to screening and background investigations before access to information systems and sensitive data.
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