BerryDunn — Assurance, Tax and Consulting · 3 weeks ago
Senior Consultant - Healthcare Compliance
United States
Full-time
Remote
Mid, Senior Level
$100K/yr - $125K/yr
3+ years expBerryDunn is seeking a Senior Consultant to join our Healthcare Group as a member of the Healthcare Compliance Practice Area. The role involves assisting clients with clinical documentation improvement, regulatory research, and coding compliance, while performing complex audit reviews and providing education to healthcare providers.
Accounting
Responsibilities
Perform comprehensive audits of facility and outpatient/professional claims for coding accuracy (i.e. CPT, HCPCS, ICD-10-CM/PCS, DRG, APC, and E/M levels)
Review clinical documentation and coding to ensure compliance with relevant payer policies, as well as applicable Federal and State regulations and coding guidelines
Conduct education sessions for physicians and other qualified healthcare practitioners based on results of clinical documentation reviews
Review billing practices for facilities and practitioners across the continuum of care
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
Analyze paid claims data reports and develop risk informed audit plans
Assist with development, review, and maintenance of compliance-related policies, procedures, and workplans
Identify, assess, and escalate potential compliance risks, including billing, documentation, privacy, and regulatory concerns
Assist clients with regulatory inquiries and payer reviews and participate in special compliance projects (e.g., external audit response, RAC review)
Analyze large data sets from EMR, billing systems, and audit tools to identify patterns, outliers, and compliance risks
Develop dashboards and reports to present audit findings, trends, and actionable insights to leadership and compliance officers
Recommend actionable improvements to policies, workflows, and coder/provider performance
Remain current with changing compliance and audit issues through ongoing education and outreach efforts
Safeguard Protected Health Information (PHI) through adherence to HIPAA privacy and security standards in all documentation and communication
Perform other duties as assigned
Qualification
Required
Minimum 3-years recent experience of 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 practitioners and staff
Skilled in applying the official coding guidelines, coding clinic determinations and CMS and other payer and regulatory compliance guidance. Requires expert coding knowledge - DRG, APR-DRG, ICD-10, CPT, HCPCS
Demonstrable Proficiency in using Word, Outlook, Excel, and PowerPoint
Excellent written and verbal communication skills
One or more nationally recognized inpatient coding compliance certification (i.e. AHIMA CCS, AAPC CIC) and professional coding certification (i.e. AAPC CPC) required
3 years' minimum relevant healthcare experience is required including specialized skills in compliance related activities
Ability to work independently, as well as in a team setting
Exceptional flexibility, organization and time management skills to manage priorities and deadlines
Adeptness in regulatory research related to clinical documentation and compliance
Prior experience using Electronic Health Record systems (Epic, Cerner, Meditech)
Ability to develop clinical documentation and coding audit tools
Understanding of sampling and basic data analytics (Pivot Tables)
Strong analytical thinking, detail orientation, excellent communication, and the ability to influence clinical staff
Capable of working independently and leading post-review and compliance education initiatives
Exhibits honesty and resilience in dynamic environments, embracing change and proactively seeking clarification when needed
Preferred
Bachelors degree, RN/LPN or other clinical credential, and/or clinical documentation improvement certification preferred
Company
BerryDunn — Assurance, Tax and Consulting
BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services.
501-1000 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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