This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Medicare Outreach & Education Specialist 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 and develops educational materials, hosts events, and analyzes data to improve provider education and reduce billing errors all while working in a fast-paced, remote environment. - Provides education to Medicare providers, coders, billers, and compliance staff. - Assists providers in developing best practices to avoid coverage and billing errors. - Focuses on ensuring a positive customer experience through relationship building with providers, CMS, and other stakeholders. Qualifications - Bachelor’s Degree in Communications, Health Education, Nursing OR related field OR equivalent combination of education and experience. - 3 or more years of experience in a role supporting Medicare. - 1 or more 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 PO&E processes. - Solid knowledge and understanding of medical billing, coding, and insurance processes. - Proficient with Microsoft Office Suite and using various modes of technology to deliver training (i.e., YouTube Channel, WebEx, etc.). - Excellent written and verbal communication skills with the ability to present complex information clearly and effectively to diverse audiences. - Strong interpersonal and relationship-building skills. - Ability to travel for onsite training and education sessions - Travel will be approximately 15% in the future. Requirements - Possess experience working with Medicare. - 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, WPS policy guidelines, coverage issues, and keep abreast on upcoming legislation, to determine areas for additional education needs. - Like to conduct outreach activities that increase provider engagement and awareness of organizational services, programs, and initiatives. - Have collaborated with clinical and administrative teams to understand provider challenges and develop targeted solutions. - Would enjoy serving as a resource for providers regarding updates in guidelines, policies, billing procedures and regulatory requirements. - Can coordinate with internal teams (i.e., Claims, Appeals, Systems, Medicare Internal Processes, Provider Enrollment) to ensure identified issues are communicated and shared with Provider Outreach & Education (POE) staff. - Can establish and maintain a POE Advisory Group (POE AG) to assist contractors in creation, implementation, and review of provider education strategies and efforts. Preferred Qualifications - CMS knowledge of the Home Health and Hospice program. - Strong facilitation, presentation and training experience to large groups of people. - MAC contractor experience with FISS, MCS and MAS systems. Benefits - Remote and hybrid work options available. - Performance bonus and/or merit increase opportunities. - 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately). - Competitive paid time off. - Health insurance, dental insurance, and telehealth services start DAY 1. - Professional and Leadership Development Programs.

Role Description - Demonstration, Schulung und Einweisung in das Sentec-Portfolio bei klinischen Anwendern vor Ort - Troubleshooting und First-Level-Support für bestehende Kunden - Positionierung von Schlüsselpublikationen und bewährten Verfahren (Best Practices), um den Einsatz der Geräte bei bestehenden Kunden zu steigern - Entwicklung und Betreuung von Verkaufsprojekten in Zusammenarbeit mit dem regionalen Sales Manager - Präsentation des Sentec-Portfolios, einschließlich der Einsatzmöglichkeiten, auf Messen, Kongressen sowie bei regionalen Produkt- und Applikationstrainings Qualifications - Abgeschlossene Ausbildung als Atmungstherapeut/in oder examinierte/r Fachkrankenpfleger/in - Idealerweise mit Fachweiterbildung im Bereich Intensivmedizin, Pneumologie, Schlafmedizin oder Neugeborenen-Intensivmedizin (oder vergleichbar) - Erfahrung in der Schulung und Ausbildung von Fachkräften im Gesundheitswesen - Fließende Deutschkenntnisse sowie gute Englischkenntnisse Requirements - Ihr Wohnsitz sollte idealerweise in der Nähe von Hannover oder in gut erreichbarer Entfernung liegen, um die Nähe zu unseren Kunden sicherzustellen - Diese Position erfordert zudem eine hohe Reisebereitschaft Benefits - Sinnstiftende Arbeit mit Produkten, die lebensrettend sind oder die Therapie von Patienten wirksam unterstützen - Flache Hierarchien und echte interdisziplinäre Arbeitsgruppen - Die Möglichkeit, Ideen einzubringen, aktiv mitzugestalten und Entscheidungen zu treffen

• Assist Medical Review Management with monitoring the medical review process • Conduct medical record reviews for complex services • Evaluate compliance with Medicare coverage, coding, and billing rules • Contribute to medical review and proposal deliverables • Participate in quality assurance activities to ensure consistency and accuracy

• Review and analyze Medicare claims sampled by the Department of Justice, using associated medical records, to make payment determinations based on coverage, coding and utilization of services and practice guidelines. • Conducts medical record claims review to determine correct coding, utilizing ICD-9-CM, ICD-10, CPT-4, and HCPCS Level II coding principles. • Review medical documentation for medical necessity utilizing clinical knowledge and CMS policies and guidelines, as well as other state and board regulations. • Conducts in-depth claims analysis of suspected over-utilizers who are suspect of fraudulent billing practices. • Completes summary report upon completion of the records review, summarizing claim determinations, clinical observations and other information requested by the DOJ. • Reviews and completes the required number of claims reviews in accordance to pre-established production standards for the project. • Produces and submits required reports according to established content and timeframes. • Communicates internally with all levels of the group. • Participates in Quality Assurance (QA) and IRR monitoring as requested. • Complies with departmental policies and procedures. • Complies with Medicare and DOJ guidelines and CMS directives, policies and regulations pertaining to integrity, fraud, overpayments, and the handling and disclosure of information. • Attends departmental and required education and training programs. • Reviews information contained in Standard Claims Processing System to determine provider billing patterns and detect fraudulent or abusive billing practices or vulnerabilities in Medicare payment policies. • Utilizes the Medicare/Medicaid guidelines for coverage determinations. • Performs in-depth research and investigation utilizing the Internet and other tools, including data analysis tools. • Maintains chain of custody on all documents, follows all confidentiality and security guidelines.