Health Care Disputes - Compliance Risk Adjustment, Senior Director - Senior Director

Ankura • Washington, DC

128d • $85,000 - $200,000

About The Position

The Senior Director will support the Healthcare Payer team within Ankura’s Disputes & Economics practice - one of seven practices focused on client delivery services across the Firm. This role will use relevant expertise, regulatory knowledge, data analytics skills and project management capabilities to deliver valued client service and deliverables based upon their unique needs and the scope of the project for which we are retained. This might include the development of custom solutions for clients requiring proactive or reactive support for compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment. The Senior Director will also support practice and firmwide business development activities and initiatives and will be required to participate and support revenue generation opportunities. They will also have oversight and management responsibilities for downline professionals including Directors, Senior Associates and Associates. They may be assigned as Performance Managers for these subordinate professionals and will support Ankura’s People Office and D&E practice management with human resource support.

Requirements

• Bachelor’s and/or master’s degree from an accredited college/university
• 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either within industry or similar work related work in a consulting firm including a Big 4 or other recognized organization.
• Robust understanding of the operational, compliance, and business issues that affect a healthcare organization, especially related to Medicare and Commercial Risk Adjustment.
• Strong time management skills and ability to manage multiple concurrent projects.
• Commitment to quality and working within a team.
• Effective oral and written communication skills.
• Ability and willingness to travel.
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Nice To Haves

• Specific experience with RADV Audit responses including managing the collection of medical records, overseeing the selection of records and submitting the records to the client.
• Experience with Risk Adjustment chase list creation, Risk Adjustment vendor audit processes, managing retrospective or prospective Risk Adjustment activities such as Chart Review or In-Home Risk Assessments.
• Knowledge of Risk Adjustment data collection and submission activities as well as knowledge of Risk Adjustment coding requirements preferably with a Risk Adjustment Coder certification.

Responsibilities

• Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients.
• Oversee and conduct data gathering activities, document review, and quality control of data assessment.
• Work with Senior Managing Directors and Managing Directors to develop thought leadership, participate in industry conferences and events, and assist with proposal and business development efforts.
• Mentor, supervise and motivate a team of associates, senior associates, and director professionals.
• Prepare client communications, both written and oral, for senior level review.
• Perform client facing tasks including operational, compliance or regulatory assessments and develop associated deliverables.
• Develop and draft proposals, RFP responses and other business development material for the acquisition of client engagements and be active in the sales process with Managing Directors and Senior Managing Directors of the D&E practice.
• Work directly with Managing Directors and Senior Managing Directors in the development of practice initiatives and educational material for internal meetings and events.
• Perform research and interpret emerging and changing regulatory requirements impacting our clients and be able to develop materials that address the same.

Benefits

• 401k
• health_insurance
• dental_insurance
• vision_insurance
• flexible_scheduling
• paid_holidays
• tuition_reimbursement

What This Job Offers

• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees