Certified Medical Coder responsible for coding diagnoses and procedures for billing and reporting. Ensuring compliance with coding guidelines and acting as a resource for medical staff.
About the role
- Senior Associate managing health care coding and compliance investigations for Ankura’s Health Care team. Leading complex investigations and ensuring project deliverables are met in a timely manner.
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
Requirements
- Certified in Risk Adjustment Coding (CRC) with at least five (5) recent years of experience in HCC/Risk Adjustment and/or RADV Audit Methodology
- 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
- Time management skills
- Prior success in managing small projects and teams
- Ability to work on multiple client projects simultaneously if needed
- Proficient in Excel, Word, and PowerPoint
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible working hours
- Professional development opportunities
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