Healthcare Compliance- Associate Director
Description
- Plan and perform medical record audits to determine coding accuracy and compliant claims submission.
- Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance.
- Design, review, and implement compliance programs consistent with OIG and other guidance.
- Perform coding and documentation audits, 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.
- Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement.
- Serve as a subject matter expert on interpretation and application of coding and documentation guidelines.
- Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas.
- Stay current on coding guidelines.
- Develop analyses using transactional data and/or financial data.
- Generate client deliverables and contribute to the experts reports.
- Manage client relationships and communicate results and work product.
- Manage junior staff and delegate assignments as directed by more senior case managers.
- Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions;
- Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting;
- Bachelor’s degree with a focus in quantitative analytics (accounting, finance, economics, mathematics, data science, statistics, health economics, biostatistics, health informatics, information systems, public health) or related field;
- Minimum of ten (10+) years of work experience with a focus on healthcare provider billing, coding and compliance;
- Active coding certification from either AAPC or AHIMA is required;
- Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation;
- Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements;
- Experience with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs).
- Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results;
- Commitment to producing high quality analysis and attention to detail;
- Excellent time management, organizational skills, and ability to prioritize work and meet deadlines;
- Exceptional verbal and written communication skills; and
- Desire to work collaboratively within an office team environment.
About BRG
Berkeley Research Group, LLC (BRG) is a global consulting firm that helps leading organizations advance in three key areas: disputes and investigations, corporate finance, and strategy and operations. Headquartered in California with over 40 offices around the world, we are an integrated group of experts, industry leaders, academics, data scientists, and professionals working beyond borders and disciplines. BRG strives to build and nurture a culture where inclusiveness is instinctive, not an initiative. We celebrate and value the diversity of our professionals and are dedicated to maintaining a truly inclusive work environment where all individuals feel respected and valued. We harness our collective expertise to deliver the inspired insights and practical strategies our clients need to stay ahead of what's next.
Berkeley Research Group is proud to be an Equal Opportunity Employer. Our hiring practices provide equal opportunity for employment without regard to race, religion, color, sex, gender, national origin, age, United States military veteran status, ancestry, sexual orientation, marital status, family structure, medical condition including genetic characteristics or information, veteran status, or mental or physical disability so long as the essential functions of the job can be performed with or without reasonable accommodation, or any other protected category under federal, state, or local law.
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