Senior Director, Health Care Disputes (Coding & Compliance)
Ankura is a team of excellence founded on innovation and growth.
Ankura’s Health Care Disputes and Life Sciences Practice advise outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research misconduct, human subject’s protection, and financial fraud related to research. Our practice is often called upon to advise investors on operational and compliance matters in the course of due diligence. We serve as the Independent Review Organization for many clients and our work product is routinely presented to the Office of Inspector General of HHS and the US Department of Justice. Our clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. This role is location agnostic and may be remote.
Responsibilities:
Proficient in medical coding, billing, and documentation requirements
Works with the Project Manager to analyze and understand client concerns and develop project work plans as requested
Understands health care compliance concepts, issues, and how to research and access regulatory guidelines and reference materials
Conducts independent review of medical records - EMR or paper documentation
Drafts clear and concise analyses of medical record review findings
Ensures successful completion of high-quality 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
Proven writing and presentation skills
Communicates findings of concern with the team and Project Manager as they are identified
Utilizes creative problem-solving techniques
Qualifications:
Associate or bachelor’s degree preferred from an accredited college/university
Current Coding Certification through either AAPC or AHIMA
Minimum 10 years health care experience related to clinical documentation, compliance, or coding of medical services
Clinical experience is a plus
Demonstrates excellent communication skills, both written and oral
Experience managing small projects and teams
Familiar with accessing and identifying clinical documentation in electronic medical record systems
Proficient in Excel, Word, and PowerPoint and able to draft reports and presentations and present findings
Ability to problem solve, multi-task, and prioritize assignments
Understands the importance of privileged and confidential communication
Willingness to travel when needed
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 [email protected] 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.
Apply To This Job
Ankura’s Health Care Disputes and Life Sciences Practice advise outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research misconduct, human subject’s protection, and financial fraud related to research. Our practice is often called upon to advise investors on operational and compliance matters in the course of due diligence. We serve as the Independent Review Organization for many clients and our work product is routinely presented to the Office of Inspector General of HHS and the US Department of Justice. Our clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. This role is location agnostic and may be remote.
Responsibilities:
Proficient in medical coding, billing, and documentation requirements
Works with the Project Manager to analyze and understand client concerns and develop project work plans as requested
Understands health care compliance concepts, issues, and how to research and access regulatory guidelines and reference materials
Conducts independent review of medical records - EMR or paper documentation
Drafts clear and concise analyses of medical record review findings
Ensures successful completion of high-quality 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
Proven writing and presentation skills
Communicates findings of concern with the team and Project Manager as they are identified
Utilizes creative problem-solving techniques
Qualifications:
Associate or bachelor’s degree preferred from an accredited college/university
Current Coding Certification through either AAPC or AHIMA
Minimum 10 years health care experience related to clinical documentation, compliance, or coding of medical services
Clinical experience is a plus
Demonstrates excellent communication skills, both written and oral
Experience managing small projects and teams
Familiar with accessing and identifying clinical documentation in electronic medical record systems
Proficient in Excel, Word, and PowerPoint and able to draft reports and presentations and present findings
Ability to problem solve, multi-task, and prioritize assignments
Understands the importance of privileged and confidential communication
Willingness to travel when needed
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 [email protected] 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.
Apply To This Job