Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder

Ankura•Washington, DC

4d•Remote

About The Position

Ankura is a team of excellence founded on innovation and growth. Practice Overview Ankura’s Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research misconduct, human subjects’ protection, and financial fraud related to research. Our practice is often called upon to advise investors on operational and compliance matters during due diligence. We serve as the Independent Review Organization for many clients and our work product is routinely presented to the Office of Inspector General of HHS and the US Department of Justice. We also work on provider / payor litigation matters where our team members serve as experts. Our clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. We will consider candidates in most major US markets.

Requirements

Registered Nurse with active license, unrestricted license.
Bachelor of Science in Nursing from an accredited college/university
Substantial clinical experience with demonstrated 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
Demonstrates 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 and able to draft reports and presentations and present findings
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, now or at any time in the future.

Responsibilities

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 as requested
Understands health care compliance concepts, issues, and how to research and access regulatory guidelines and reference materials
Conducts independent review of medical records – EMR (electronic medical records) or paper documentation
Drafts clear and concise analyses of medical record review and coding findings
Ensures successful completion of high-quality project deliverables as assigned and within the desired timeframe
Works collaboratively with Ankura team members focusing on building and maintaining internal and external client and counsel relationships
Proven writing and presentation skills and has a keen sense of attention to detail
Communicates findings of concern with the team and Project Manager as they are identified
Utilizes creative and critical thinking problem-solving techniques