Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder

Ankura Health Care Disputes, Compliance and Investigations Practice

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

Practice Overview

Ankura's Health Care Disputes, Compliance and Investigations practice advises 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 subjects' protection, and financial fraud related to research. Our practice is often called upon to advise investors on operational and compliance matters during 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. We also work on provider / payor litigation matters where our team members serve as experts. 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. We will consider candidates in most major US markets.

Responsibilities:

• Demonstrates proficiency in medical coding, billing, clinical documentation, and regulatory standards
• Works with Project Managers 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 (electronic medical records) or paper documentation
• Drafts clear and concise analyses of medical record review and coding 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 and has a keen sense of attention to detail
• Communicates findings of concern with the team and Project Manager as they are identified
• Utilizes creative and critical thinking problem-solving techniques

Qualifications:

• Registered Nurse with active license, unrestricted license.
• Bachelor of Science in Nursing from an accredited college/university
• Substantial clinical experience with demonstrated ability to interpret clinical documentation and medical necessity
• Certified Professional Coder (CPC) with coding experience across inpatient, outpatient, and professional services
• Familiar with the revenue cycle process and facility and professional claims
• 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
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.