Director, Registered Nurse / Certified Risk Adjustment Coder (CRC)

Ankura Health Care Team Opportunity

Ankura is a team of excellence founded on innovation and growth.

Practice Overview

Ankura's Health Care team is a recognized leader in health care disputes, compliance, and investigations. Our clients and their counsel rely upon us to advise them on a wide variety of complex health care and regulatory matters. 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 and Quality Monitorship for many clients, and our work product is routinely presented to the Office of Inspector General of HHS and the US Department of Justice. 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.

Responsibilities

• Applies clinical experience and acumen to client engagements
• Knowledgeable with medical record documentation and understand regulatory compliance guidelines and policies
• Competent in medical coding
• Proficient in review of revenue cycle data including EOBs, 837 / 835 data, and payer denial information
• Works with the Project Manager to analyze and understand client concerns and develop project work plans
• Conducts independent review of medical records
• Drafts clear and concise analyses of medical record review findings
• Prepares clear and concise analyses of clinical and revenue cycle data including that from payers
• 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
• Communicates findings of concern with the team and Project Manager as they are identified
• Utilizes creative problem-solving techniques

Qualifications

For individuals assigned and / or hired to work in California, Colorado, or New York, Ankura is required to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the said markets and considers a broad range of factors including but not limited to skill sets, experience and training, licensure and certifications, and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. The range does not include additional benefits outside of salary. At Ankura, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each role. A reasonable estimate of the current base pay range is between $85,000 to $200,000; this range is not a promise of a particular wage.

Ankura is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability. Equal Employment Opportunity Posters.