Certified Risk Adjustment Coder (CRC), Senior Associate

Sr. Associate, Health Care

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

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 Sr. Associates 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
• 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.

For individuals assigned and/or hired to work in California, Colorado, or New York, Ankura is required to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the said markets and considers a broad range of factors including but not limited to skill sets, experience and training, licensure and certifications, and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. The range does not include additional benefits outside of salary. At Ankura, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each role. A reasonable estimate of the current base pay range is between $85,000 to $200,000; this range is not a promise of a particular wage.