[Hiring] Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder @Ankura

Role Description

Ankura’s Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters.

• Provide expert witness testimony on commercial disputes involving payers and providers
• Assist with matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations
• Work with Chief Compliance Officers to build and mature compliance programs
• Conduct program effectiveness reviews and risk assessments
• Perform compliance audits
• Assist in-house and outside counsel during investigations through evaluation of medical records
• Determine medical necessity and appropriate medical coding
• Compute financial impacts that may lead to repayments
• Provide investigative assistance in matters involving research misconduct and financial fraud related to research
• Advise investors on operational and compliance matters during due diligence
• Serve as the Independent Review Organization for many clients
• Work on provider/payor litigation matters as experts

Qualifications

• Registered Nurse with active, unrestricted license
• Bachelor of Science in Nursing from an accredited college/university
• Substantial clinical experience with 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
• 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
• 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

Requirements

• 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
• Understands health care compliance concepts and how to research regulatory guidelines
• Conducts independent review of medical records – EMR or paper documentation
• Drafts clear and concise analyses of medical record review and coding findings
• Ensures successful completion of high-quality project deliverables within the desired timeframe
• Works collaboratively with Ankura team members to build and maintain client and counsel relationships
• Proven writing and presentation skills with attention to detail
• Communicates findings of concern with the team and Project Manager as identified
• Utilizes creative and critical thinking problem-solving techniques

Company Description