[Remote] Managing Consultant - Risk Adjustment Coding Compliance

Note: The job is a remote job and is open to candidates in USA. BRG is a consulting firm specializing in healthcare analytics, seeking a Managing Consultant for their Coding Compliance team. The role involves auditing provider claims and clinical documentation, developing audit specifications, and ensuring compliance with coding guidelines.ResponsibilitiesAudit Planning: Has the ability to design coding and documentation audit plans for annual and periodic audits and investigations, using knowledge of key risk areas in coding and documentation complianceConducting Audits and Critiquing External Audits: Performs coding and documentation audits by reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines. Work will include reviewing the results of audits conducted by external parties (e.g., CMS RADV audits) and assisting with both identifying records for appeal and drafting narrative appealsAnalysis, Reporting, and Education: Conducts analysis of audit findings to identify trends/problems in coding and documentation and effectively and recommend areas for improvement. May also lead educational meetings with providers/health plans/legal counsel to review the audit findingsCompliance Program Activities: Has the ability to assist with reviewing, editing, or writing policies and procedures related to billing and coding compliance risk adjustment operations, and provider/coder education trainingsOther job responsibilities include:Serves as a subject matter expert on interpretation and application of coding and documentation guidelinesRecommends procedural or policy changes to improve coding and documentation practices based on industry knowledge and audit findingsMonitors relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areasStays current on coding guidelines, risk adjustment reimbursement requirements, and changes to the CMS-HCC modelGenerates client deliverables and make valuable contributions to expert reportsManages client relationships and communicate results and work product as appropriateManages junior staff and delegate assignments as directed by more senior managersDemonstrates creativity and efficient use of relevant software tools and analytical methods to develop solutionsParticipates in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruitingPrioritizes assignments and responsibilities to meet goals and deadlinesComplies with HIPAA laws and regulations and all applicable company rules and policiesSkillsBachelor Degree in Health Information Management or related healthcare fieldMinimum of 5 years of risk adjustment coding experience as an auditor/coder within a health plan or medical group/physician office settingMinimum of 3 years of medical coding experience (CPT-4/HCPCS and ICD-10-CM) in a medical group/physician office settingActive certification in medical coding (CPC or CCS-P) through AAPC or AHIMA, as well as active certification as a risk adjustment coder (CRC) through AAPCComprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentationAdvanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements, including Physician, Multi-Specialty, Surgical, Hospital, Lab, Pharmacy, or other related Code Sets, with ability to research coding related questionsDemonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and toolsDemonstrated ability to identify issues in coding and documentation practices and develop plans to remediateDemonstrated ability to develop reports, track, and trend audit findings and resultsDemonstrated ability to make timely and appropriate judgements on audit findings and translate into needed actions and follow up plansDemonstrated ability to effectively communicate with stakeholders regarding coding and documentation improvementCommitment to producing high quality analysis and attention to detailExcellent verbal/written communication skillsKeen interest in healthcare compliance and healthcare policyExcellent time management, attention to detail, follow up skills, organizational skills, and ability to prioritize work and meet deadlinesProficient user in MS office suite: Excel, Outlook, PowerPoint, Word. A desire to expand those capabilities is required, as is the ability to train others to use such toolsPreference will be given to candidates who are certified in medical auditing, certified in healthcare compliance, and/or current or former licensed clinicians (e.g., RN)Company OverviewBRG combines world-leading academic credentials with world-tested business expertise, purpose-built for agility and connectivity, which sets us apart—and gets our clients ahead. It was founded in 2010, and is headquartered in Emeryville, California, USA, with a workforce of 1001-5000 employees. Its website is http://www.thinkbrg.com.