PACE Health Care Senior Consultant

Essential Functions and Primary Duties The Health Care Senior Consultant will independently review/audit medical records associated with claims and work in a team environment on fraud, waste and abuse and program compliance issues for engagements with government healthcare programs, including primarily the Medicaid and Medicare programs Utilizing healthcare knowledge and experience to review medical records for various types of medical services for accuracy, completeness and consistency with professional standards and compliance with billing and coding requirements Documenting and reporting findings of reviews and audits in accordance with professional standards and project protocols Participating in on‑site field examinations of providers to review clinical documentation Interpreting and analyzing health care data Working with state client personnel on health care reimbursement and compliance issues, including recommending changes and improvements of policies to ensure provider compliance Working collaboratively with the medical director and other clinical staff in the development and management of fraud, waste and abuse detection and other compliance projects Developing and maintaining general knowledge of reimbursement regulations, provider billing manuals and other Medicaid policies for claim payment compliance reviews and documentation to support current audit findings Participating in and contributing to quality management systems Additional responsibilities as assigned Maintaining security of and confidentiality of all protected health information (PHI) Preferred Qualifications Bachelor's degree in related field or equivalent experience At least 3 years of related experience Certification Experience and knowledge of state and federal healthcare regulations, including reimbursement and coverage policies Proficient use of applicable software tools, including Microsoft Windows, Word, Excel, and Access Strong analytical and problem‑solving skills Excellent communication skills including written and verbal, including ability to present to large or small groups Self‑directed and motivated, with ability to work independently under general instructions Ability to work in a team environment and manage multiple deadlines and prioritize assignments Well organized with a high degree of accuracy and attention to detail Ability to travel based on client and business needs Minimum Qualifications High school diploma or GED Benefits Health, Dental, and Vision insurance along with other competitive employee benefits for eligible associates Vacation time, sick time, and paid holidays Paid Parental Leave and available support resources 401K with company matching for eligible employees Tuition reimbursement, referral bonuses, paid volunteer community service time, mentor program, and a variety of other employee programs and perks A combination of technical and leadership development training at each career milestone Up to six counseling sessions per year for eligible employees through our Employee Assistance Program Equal Opportunity Employer. CBIZ is an equal opportunity employer and reviews applications for employment without regard to the applicant's race, color, religion, national origin, ancestry, age, gender, gender identity, marital status, military status, veteran status, sexual orientation, disability, medical condition or any other reason prohibited by law. If you would like more information about your EEO rights under the law, please visit Know Your Rights. Reasonable Accommodation. If you are a qualified individual with a disability, you may request reasonable accommodation if you are unable or limited in your ability to use or access this site as a result of your disability. #J-18808-Ljbffr CBIZ