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:

Bachelor’s degree in nursing from an accredited college/university

Current Registered Nurse license

Experience working for payors conducting risk adjustment reviews

Clinical experience in a variety of specialties, settings, and provider types

Minimum 10 years’ health care experience related to clinical care, clinical documentation, compliance, or coding of medical services

Medical coding certification (will consider non-coders with an aptitude to develop this level of skill within a defined period) 

Certification in the following are preferred - AHIMA, CCS, CIC, COC, CPC, CRC

Demonstrates excellent communication skills, both written and oral

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.

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.

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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, if you have a disability and believe you need a reasonable accommodation to search for a job opening, submit an online application, or participate in an interview/assessment, please email accommodations@ankura.com or call toll-free +1.312-583-2122. This email and phone number are created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues unrelated to a disability, will not receive a response.