Senior Director, Healthcare Risk Management & Advisory | Forensic and Litigation Consulting

About the role

The Healthcare Risk Management & Advisory (HRMA) practice at FTI Consulting works across corporate engagements and litigation matters to deliver data-driven solutions to clients. The team serves clients in the healthcare sector, including health systems, payors, and life sciences companies, as well as those with whom they do business.

Responsibilities

• Work within diverse teams to assist clients and counsel in reviewing medical records to evaluate services provided and compliance with various regulations.
• Review medical records, document findings and rationale, and communicate insights and recommendations to client executives.
• Examine outpatient, physician office, and inpatient medical records; validate code assignments and reimbursement based on medical record documentation.
• Research and summarize billing, coding, and reimbursement regulations for discussions with client and counsel.
• Articulate complex coding and clinical terminology to internal teams, clients, and counsel.
• Prepare detailed written analyses of medical record reviews and coding findings, including citations to applicable regulatory requirements and coding guidelines.
• Guide project strategy and approach for coding engagements, including coordinating team efforts and communicating key insights and recommendations.
• Provide education to physicians and staff on documentation guidelines.
• Review and revise client policies related to coding and clinical documentation.

Qualifications

• Bachelor’s Degree
• Current/active coding certification: CPC, CCS, COC
• 10+ years total working experience, 8+ years in medical coding or clinical documentation improvement
• Proficient in grouper software, coding reference books, and EMR systems like EPIC, Cerner, Athena, AdvancedMD
• Proficient in Microsoft Office Suite
• Ability to work independently and as part of a team in a fast-paced, multi-tasking environment
• Strong communication and organizational skills
• Flexibility with respect to assigned tasks and engagements
• Basic knowledge of clinical documentation requirements, coding guidelines, regulatory requirements, reimbursement methodologies, and clinical workflows
• Knowledge of APC assignment logic, National Correct Coding Initiative edits, ICD-10-CM/PCS Official Coding Guidelines, AHA Coding Clinic, and CPT Assignment coding guidelines
• Medical Laboratory Scientist (MLS) ASCP Certification or equivalent experience in a laboratory setting
• Testifying, mediation, or arbitration experience
• Demonstrated experience in auditing and monitoring