Senior Consultant - Healthcare Compliance

Overview:

BerryDunn is seeking a Senior Consultant, Healthcare Compliance to join our Healthcare Group. You will join a core team tasked with assisting the firm’s clients with clinical documentation improvement, revenue integrity efforts, regulatory research, and general coding and billing compliance in a multitude of healthcare settings. This position is planned to sit remotely reporting to leaders who also sit remotely in Connecticut.

The record auditing aspect of this role will focus primarily on MS-DRG and APR-DRG coding & clinical documentation compliance validation for our inpatient acute hospital and health system clients. The ideal candidate for this position needs to have both a clinical and coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG, and professional CPT and ICD-10 coding. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on clinical review, coding accuracy, and the appropriateness of treatment setting and services delivered.

• Conduct high volume of coding compliance audits
• Review documentation and coding to ensure compliance with all Federal and State guidelines. Ensure correct DRG and APC assignments for Institutional claims.
• Conduct accurate clinical documentation reviews for professional and facility claims. 
• Conduct medical coding education sessions based upon the clinical documentation reviews conducted
• Review billing practices for healthcare entities and practitioners across the continuum of care.
• Conduct documentation improvement education sessions for physicians, other qualified healthcare practitioners providing professional services.
• Reinforce proper coding, documentation, and billing consistent with client internal policies as well as State and Federal regulatory and reimbursement guidelines, maintain compliance while optimizing appropriate revenue opportunities. 
• Perform independent research, assessment and remain current with CMS, NGS Medicare, and Office of Inspector General (OIG) regulations, guidelines, bulletins, coding practices & methods, annual, semi-annual, and quarterly coding updates and other publications for impact on Institutional services. Monitor daily notifications and listservs such as CMS, Medicare, NGS, AHIMA, etc., and third-party payers for updates and changes in regulations and professional and peer organizations/practices/policies/guidelines to keep current with regulatory requirements and accepted compliance and audit practices.
• Remain current with changing compliance and audit issues through ongoing education and outreach efforts. 
• Achieve the organization's established expectations in regard to customer service, teamwork, and safety. 
• Fulfill all compliance responsibilities related to the position.
• Perform other duties as assigned.

Requied Experience:

• 3 to 5+ years of working with MS-DRG, AP-DRG and APR-DRG, professional and outpatient CPT and ICD-10 coding/auditing with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
• Experience in developing and providing audit outcomes to practitioner and staff
• Skilled in the official coding guidelines, coding clinic determinations and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge - DRG, APR-DRG, ICD-10, CPT, HCPCS codes.
• Requires working knowledge of and applicable industry-based standards.
• Proficiency in Word, Outlook, Excel and PowerPoint and other applications.
• Excellent written and verbal communication skills

Qualifications:

• One or more nationally recognized professional inpatient coding compliance certifications (ie: AHIMA CCS, AAPC CIC) required.
• Bachelor’s degree, RN/LPN or other clinical credential, and/or clinical documentation improvement certification preferred
• 3 years minimum of relevant healthcare experience is required including specialized skills in compliance related activities.
• Ability to work independently, as well as, in a team setting
• Exceptional organization and time management skills to manage priorities and deadlines
• Adeptness in regulatory research related to clinical documentation and compliance
• Effective verbal, interpersonal, and written skills
• Strong attention to detail and quality
• Proficiency with Microsoft Office suite (Word, Outlook, Excel and PowerPoint)

The base salary range targeted for this role is $100,000 - $115,000. This salary range represents BerryDunn’s good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications in excess of the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations.

Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn.

About BerryDunn

BerryDunn is a leading national professional services firm providing assurance, tax, and consulting services to businesses, nonprofits, and government agencies throughout the US and its territories. Since 1974, we have been a client-centered, people-first firm with a mission to empower the meaningful growth of our people, clients, and communities. Led by CEO Sarah Belliveau, the firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being. Learn more at berrydunn.com.

We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process,or perform essential job functions. Please contact careers@berrydunn.com to request an accommodation.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

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