BerryDunn — Assurance, Tax and Consulting · 19 hours ago
Senior Consultant - Healthcare Compliance
United States
Full-time
Remote
Mid, Senior Level
$100K/yr - $115K/yr
3+ years exp
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Responsibilities
Conduct high volume of coding compliance audits
Review documentation and coding to ensure compliance with all Federal and State guidelines. Ensure correct DRG and APC assignments for Institutional claims.
Conduct accurate clinical documentation reviews for professional and facility claims.
Conduct medical coding education sessions based upon the clinical documentation reviews conducted
Review billing practices for healthcare entities and practitioners across the continuum of care.
Conduct documentation improvement education sessions for physicians, other qualified healthcare practitioners providing professional services.
Reinforce proper coding, documentation, and billing consistent with client internal policies as well as State and Federal regulatory and reimbursement guidelines, maintain compliance while optimizing appropriate revenue opportunities.
Perform independent research, assessment and remain current with CMS, NGS Medicare, and Office of Inspector General (OIG) regulations, guidelines, bulletins, coding practices & methods, annual, semi-annual, and quarterly coding updates and other publications for impact on Institutional services. Monitor daily notifications and listservs such as CMS, Medicare, NGS, AHIMA, etc., and third-party payers for updates and changes in regulations and professional and peer organizations/practices/policies/guidelines to keep current with regulatory requirements and accepted compliance and audit practices.
Remain current with changing compliance and audit issues through ongoing education and outreach efforts.
Achieve the organization's established expectations in regard to customer service, teamwork, and safety.
Fulfill all compliance responsibilities related to the position.
Perform other duties as assigned.
Qualification
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Required
3 to 5+ years of working with MS-DRG, AP-DRG and APR-DRG, professional and outpatient CPT and ICD-10 coding/auditing with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
Experience in developing and providing audit outcomes to practitioner and staff
Skilled in the official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APR-DRG, ICD-10, CPT, HCPCS codes.
Requires working knowledge of and applicable industry-based standards.
Proficiency in Word, Outlook, Excel and PowerPoint and other applications.
Excellent written and verbal communication skills
One or more nationally recognized professional inpatient coding compliance certifications (ie: AHIMA CCS, AAPC CIC) required.
3 years minimum of relevant healthcare experience is required including specialized skills in compliance related activities.
Ability to work independently, as well as, in a team setting
Exceptional organization and time management skills to manage priorities and deadlines
Adeptness in regulatory research related to clinical documentation and compliance
Effective verbal, interpersonal, and written skills
Strong attention to detail and quality
Proficiency with Microsoft Office suite (Word, Outlook, Excel and PowerPoint)
Preferred
Bachelor’s degree, RN/LPN or other clinical credential, and/or clinical documentation improvement certification preferred
Company
BerryDunn — Assurance, Tax and Consulting
BerryDunn is a nationally recognized firm providing assurance, tax, and consulting services.
501-1,000 employees
Funding
Current Stage
Late StageLeadership Team
Charles S.
Chief Operating Officer of Consulting Services
Renee Bishop
Chief Operating Officer, Assurance, Tax and Advisory Services
Recent News
2024-04-19
2023-11-21
2023-01-04
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