WPS—A health solutions company
Clinical Medicare Outreach and Education Specialist (HH & H)
WPS—A health solutions company, Indiana, Pennsylvania, us, 15705
Role Overview
Clinical Medicare Outreach and Education Specialist (HH & H) within WPS—A health solutions company. This role develops and delivers educational content to the provider community regarding current and upcoming CMS regulations, creates and develops educational materials, hosts events, analyzes data to improve provider education, reduce billing errors, and support a positive customer experience through relationship building with providers, CMS, and other stakeholders. Responsibilities
Develop educational materials, host events, and analyze data to improve provider education and reduce billing errors. Educate Medicare providers (physicians, NPs, PAs, nurses, therapists, coders, billers, and compliance staff) on Medicare programs and upcoming changes. Assist providers in developing best practices to avoid coverage and billing errors, reducing error rates, and protecting the Medicare Trust Fund. Engage with internal teams (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate and share identified issues with Provider Outreach & Education 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 as a Medical Review Nurse Analyst with Medicare principles and guidelines. 3+ years in a role supporting Medicare. 1+ years 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 Provider Outreach & Education processes. Solid knowledge of medical billing, coding, and insurance processes. Proficient with Microsoft Office Suite and delivering training via various platforms (e.g., YouTube, 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 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 (ethernet from router to computer). High-speed cable or fiber internet. Minimum of 10 Mbps downstream and 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 matching. Competitive paid time off. Health, dental, and telehealth services start Day 1. Professional and Leadership Development Programs. About WPS
WPS is a not-for-profit health insurer and federal government contractor headquartered in Madison, WI. We provide health plans and manage Medicare-related services for beneficiaries and military personnel. We are committed to a culture that values diverse perspectives, employee engagement, and continuous learning.
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Clinical Medicare Outreach and Education Specialist (HH & H) within WPS—A health solutions company. This role develops and delivers educational content to the provider community regarding current and upcoming CMS regulations, creates and develops educational materials, hosts events, analyzes data to improve provider education, reduce billing errors, and support a positive customer experience through relationship building with providers, CMS, and other stakeholders. Responsibilities
Develop educational materials, host events, and analyze data to improve provider education and reduce billing errors. Educate Medicare providers (physicians, NPs, PAs, nurses, therapists, coders, billers, and compliance staff) on Medicare programs and upcoming changes. Assist providers in developing best practices to avoid coverage and billing errors, reducing error rates, and protecting the Medicare Trust Fund. Engage with internal teams (Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to communicate and share identified issues with Provider Outreach & Education 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 as a Medical Review Nurse Analyst with Medicare principles and guidelines. 3+ years in a role supporting Medicare. 1+ years 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 Provider Outreach & Education processes. Solid knowledge of medical billing, coding, and insurance processes. Proficient with Microsoft Office Suite and delivering training via various platforms (e.g., YouTube, 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 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 (ethernet from router to computer). High-speed cable or fiber internet. Minimum of 10 Mbps downstream and 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 matching. Competitive paid time off. Health, dental, and telehealth services start Day 1. Professional and Leadership Development Programs. About WPS
WPS is a not-for-profit health insurer and federal government contractor headquartered in Madison, WI. We provide health plans and manage Medicare-related services for beneficiaries and military personnel. We are committed to a culture that values diverse perspectives, employee engagement, and continuous learning.
#J-18808-Ljbffr