Provider Outreach Education Rep II - Iowa Medicaid

• Position is eligible for Remote / Work from Home opportunity

Department: Provider Contact Center - Iowa Medicaid

Talent Partner: Elizabeth Fleming

Telecommuting Eligible: Yes

Job Grade: N15

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Job Title

Provider Outreach and Education Representative II

Job Summary

The Provider Outreach and Education (POE) Representative is responsible for providing education to providers/suppliers that focuses on reducing the Comprehensive Error Rate Testing (CERT) and reducing claim submission errors based on data analysis. This position produces educational material and web content on topics including enrollment, billing, coding, and new initiatives and delivers education through various innovative technologies.

Key Performance Indicators

• Provides one-on-one provider/supplier education

• Collects and analyzes data to track and trend for purposes of education and reduction of workloads in respective operational teams affected

• Excellent interpersonal and communication skills with the ability to lead in a group setting

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Educates, coordinates, and facilitates provider/supplier education opportunities via teleconference, online venues, leading in-person work groups, or group settings as the Subject Matter Expert (SME)

• Provides quality education in a timely manner to meet internal and external standards as outlines by the Centers for Medicare & Medicaid Services (CMS)

• Analyzes data and tracks trends in claim submission errors, appeals, telephone and written inquiries, or other data from operational teams, and educates as appropriate

• Maintains extensive knowledge of CMS rules, regulations, processing guidelines, and online reference information

• Communicates and coordinates with internal departments and senior leadership for educational opportunities that will help improve the workloads (volume, content, promotion of updates/changes, etc.) for each operational team, as applicable

• Researches, problem solves, and responds to complex inquiries from internal and external customers within specified timeframes

• Participates in, and actively supports, internal/external committee meetings such as Medicare Carrier Advisory Committee (CAC), coverage meetings, and Ask the Contractor Teleconferences (ACTs), etc.

• Creates and updates written publications, 508 accessibility compliant content for web pages, presentations, and proposals for national speaking opportunities

• Coaches and mentors' peers/employees on the education process, Medicare policies, standards, requirements, metrics, etc.

• Actively contributes or takes the initiative to plan the upcoming years' education events, such as onsite travel, webinars, and the contractor, etc.

• Ensure CMS reporting requirements are met with detailed information

• Creates and updates internal control documentation to stay in compliance with International Organization of Standards (ISO) metrics

• Understands and applies confidentiality and security guidelines

• Identifies process improvement opportunities and takes initiatives to streamline and communicate to management team

• Serves as an expert witness at trials

• Actively leads association planning and meetings, and ensures positive relationship with outreach activity partnerships

• Mentors and coaches level I staff while fine-tuning leadership skills

• Identifies training opportunities and facilitates team or individual training

• Track, identifies trends, and assigns POE referrals

• Coordinates all ACTs, POE Advisory Groups (POEAGs), Durable Medical Equipment (DME) Advisory Council (DACs) or related recurring CMS mandated meetings

• Significantly contributes to the team reporting responsibilities submitted to CMS, management, external suppliers/providers, etc.

• Is the primary stakeholder in planning the upcoming years' education events, such as onsite travel, webinars, ACTs, etc. with management and representatives

• Demonstrates leadership qualities measured by facilitation, achieving defined outcomes, and task distribution

• Develops and maintains a training plan to meet ISO requirements

• Meets with management monthly to share recommendations and observations on team needs

• Acts as the primary event panelist to support Level I outreach by answering complex questions

Non-Essential Duties and Functions

• Creates and interprets data analysis and runs reports as needed

• Other duties as assigned

Minimum Qualifications

• Associates degree or 4 years' Medicare experience

• 3 years' in an Education Rep I or equivalent role

• Experience and knowledge of multiple lines of business

• Demonstrated successful planning and leadership skills

• Strong written and verbal communication skills

• Professional writing skills

• Demonstrated problem solving skills

• Ability to plan, organize and prioritize

• Ability to work under time constraints

Preferred Qualifications

Above requirements and the following:

• 4 years' Medicare experience

• Prior training and/or public speaking experience

• Previous call center experience

• Knowledge of the Medicare claims processing program

• Knowledge of CMS regulations and guidance

Environment and Cognitive/Physical Demands

• Office Environment

• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve

• Requires prolonged sitting and telephone use

• Requires the use of office equipment such as computer terminals, telephones, copiers and printers

• Infrequent lifting to 40 pounds

• Require sitting, standing, walking, stooping, kneeling, carrying, reaching, pushing, and pulling

• Travel up to 30%

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

Below is the salary range for potential new hires.

Salary Range: $21.91 - $36.32 per hour

Other Compensation: Incentive Plan

This job will be closed 05/08/2024 at 8:00AM CST. No further applications will be considered.