Principal Toxicologist – Health Scientist – Risk Assessor
GSI Environmental Inc.
Certified Risk Adjustment Coder, CRC, Senior Associate
Ankura
full-time
Posted on:
Location: California, District of Columbia, Illinois, Kentucky, New York • 🇺🇸 United States
Visit company websiteSalary
💰 $85,000 - $200,000 per year
Job Level
Senior
About the role
- Ankura’s Health Care team is a recognized leader in health care disputes, compliance, and investigations
- Sr. Associates use coding, revenue cycle, and clinical operations experience to contribute to complex investigations, whistleblower lawsuits, internal investigations, payer/provider disputes, and acquisition due diligence
- Review, analyze, and code diagnoses based on information in a patient's medical record according to specific guidelines for each project
- Evaluate compliance with ICD-10-CM, third-party reimbursement policies, regulations, and accreditation guidelines
- Communicate effectively with internal and external stakeholders and work with Project Managers to develop project work plans
- Draft clear and concise analyses of medical record review and coding findings and ensure successful completion of project deliverables
- Work collaboratively with Ankura team members and counsel, identify opportunities for cross-practice collaboration, and present findings
- Maintain a keen attention to detail, communicate findings of concern to the team, and independently deliver work while seeking additional development opportunities in risk adjustment 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
- Associate’s or Bachelor’s degree preferred, but not required
- Strong understanding of clinical terminology, disease processes, anatomy and pharmacology
- Intermediate to advanced understanding of 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 and in a fast-paced environment while maintaining high quality
- Proficient in Excel, Word, and PowerPoint; able to draft reports and present findings
- Understands attorney-client privilege 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 in the future
