Certified Risk Adjustment Coder (CRC), Senior Director

Ankura • Nevada, Nevada • 2h ago

Ankura is a team of excellence founded on innovation and growth.

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Practice Overview:

Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. We combine unparalleled clinical, technical, and operational expertise with financial, economic, analytic skills. Our clients and their legal counsel rely upon us to successfully resolve complex matters. Ankura's health care team is comprised of clinicians, certified coders, revenue cycle, and operations professionals. Our practice leaders each have over 25 years of health care and consulting experience. The Ankura team has a mastery of the data and information systems used by providers, payers, and CMS. We combine in-depth operational, compliance, and clinical industry knowledge with exceptional data analytics, information-gathering, and forensic skills enabling us to help our clients and their legal counsel assess and quantify the potential impact of a dispute. Our clients include the largest and most prominent US health care providers, payers, and law firms.

Role Overview:

Our Senior Directors use their experience and knowledge related in coding, revenue cycle and clinical operations, along with their project management capabilities, to contribute to complex investigations, whistleblower lawsuits, internal investigations, payer/provider disputes, and acquisition due diligence, among others.

Responsibilities:

Review, analyze, and code diagnoses based on information in a patient's medical record according to specific guidelines for each project.

Evaluate compliance with established ICD-10 CM, third party reimbursement policies, regulations and accreditation guidelines.

Communicate effectively with internal and external stakeholders according to project requirements.

Works with Project Managers to understand client needs and develop project work plans accordingly.

Understands Healthcare Compliance concepts, issues, and how to research and access regulatory guidelines and reference materials

Drafts clear and concise analyses of medical record review and coding findings.

Ensures successful completion of project deliverables as assigned and within the desired timeframe.

Works collaboratively with Ankura team members focusing on building and maintaining internal and external client and counsel relationships.

Identifies opportunities for cross practice collaboration.

Proven writing and presentation skills and has a keen sense of attention to detail.

Communicates findings of concern with the team and Project Manager as they are identified.

Can independently deliver work and seeks to gain additional opportunities for development in a variety of risk adjustment related areas.

Qualifications:

Certified in Risk Adjustment Coding (CRC) with at least five (5) recent years of experience in HCC/Risk Adjustment and/or RADV Audit Methodology or related experience.

Associate's or Bachelor's degree preferred, but not required.

Strong understanding of clinical terminology, disease processes, anatomy and pharmacology.

Intermediate to advanced understanding of in claims processing procedures, state and federal regulations, and Medicare Part D requirements.

Excellent written and verbal communication skills, ability to work in a remote environment, and time management skills.

Prior success in managing small projects and teams and able to Ability to be able work on multiple client projects simultaneously, if needed.

Ability to work in a fast-paced environment while maintaining high quality.

Proficient in Excel, Word, and PowerPoint and able to draft reports and presentations and present findings.

Understands the importance of attorney-client privileged and confidential communication.

Willingness to travel when needed.

Willingness to perform a variety of skill based tasks related to risk adjustment work.

Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Ankura is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability. Equal Employment Opportunity Posters, if you have a disability and believe you need a reasonable accommodation to search for a job opening, submit an online application, or participate in an interview/assessment, please email accommodations@ankura.com or call toll-free +1.312-583-2122. This email and phone number are created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues unrelated to a disability, will not receive a response.

Ankura Consulting Group, LLC is an independent global expert services and advisory firm that delivers services and end-to-end solutions to help clients at critical inflection points related to conflict, crisis, performance, risk, strategy, and transformation. The Ankura team consists of more than 2000 professionals serving 3,000+ clients across 55 countries who are leaders in their respective fields and areas of expertise. Collaborative Lateral Thinking That Delivers??, hard-earned experience, expertise, and multidisciplinary capabilities drive results and Ankura is unrivalled in its ability to assist clients to Protect, Create, and Recover Value??. For more information, please visit, ankura.com.

Ankura

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