Healthcare Compliance- Associate Director - Berkeley Research Group

Berkeley Research Group

Our healthcare practice provides accounting, economic, and operational advice to a variety of clients including providers and payers of healthcare services. We perform regulatory, reimbursement, data analytics, and compliance auditing for healthcare providers, healthcare payers and healthcare investors. Compliance audit deliverables include assessment of provider compliance programs and auditing of billing and coding of clinical documents and claims documents. The Associate Director for our healthcare analytics practice requires a highly motivated problem solver with strong analytical ability, solid organizational skills, and a desire to advance within the organization. This role involves the execution of engagement work streams that will primarily involve employing certified coding skills to audit provider claims and provider clinical documentation with a particular focus on government paid programs such as Medicare, Medicaid, Federal Employees Program, and TriCare. Responsibilities include working with a team to develop audit specifications, expert analysis of healthcare claims and supporting documentation, quality control, and development of client deliverables. Job Responsibilities:

• Plan and perform medical record audits to determine coding accuracy and compliant claims submission.
• Develop coding and documentation audit methodology using knowledge of key risk areas in coding and documentation compliance.
• Design, review, and implement compliance programs consistent with OIG and other guidance.
• Perform coding and documentation audits, reviewing medical records and charges to ensure compliance with CPT-4/HCPCS and ICD-10-CM coding guidelines and standards, as well as the Centers for Medicare & Medicaid Services (CMS) coverage guidelines.
• Conduct analysis of audit findings to identify trends/problems in coding and documentation and effectively communicates the audit findings and recommended areas for improvement.
• Serve as a subject matter expert on interpretation and application of coding and documentation guidelines.
• Monitor relevant resources, publications, and current government compliance and enforcement activity related to high-risk compliance areas.
• Stay current on coding guidelines.
• Develop analyses using transactional data and/or financial data.
• Generate client deliverables and contribute to the experts reports.
• Manage client relationships and communicate results and work product.
• Manage junior staff and delegate assignments as directed by more senior case managers.
• Demonstrate creativity and efficient use of relevant software tools and analytical methods to develop solutions;
• Participate in group practice meetings, contribute to business development initiatives and office functions such as staff training and recruiting;

Qualifications:

• Bachelor’s degree with a focus in quantitative analytics (accounting, finance, economics, mathematics, data science, statistics, health economics, biostatistics, health informatics, information systems, public health) or relatedfield;
• Minimum of ten (10+) years of work experience with a focus on healthcare provider billing, coding and compliance;
• Active coding certification from either AAPC or AHIMA is required;
• Comprehensive knowledge of Medicare rules, regulations, and guidelines as they apply to coverage, coding, and provider documentation;
• Advanced knowledge of CPT-4, HCPCS, and ICD-10-CM coding systems, guidelines, and regulatory requirements;
• Experience with physician practice coding (e.g. primary care, dermatology, orthopedics, ophthalmology), ASC coding, and/or post-acute coding (e.g. hospice, home health, SNFs).
• Demonstrated ability to interpret national coding and documentation guidelines and translate them into effective auditing practices and tools; identify issues in coding and documentation practices and recommend corrective action; develop reports, track, and trend audit findings and results;
• Commitment to producing high quality analysis and attention to detail;
• Excellent time management, organizational skills, and ability to prioritize work and meet deadlines;
• Exceptional verbal and written communication skills; and
• Desire to work collaboratively within an office team environment.

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BRG is an Equal Employment Opportunity/Affirmative Action Employer. All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status.


Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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