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 specializes in providing strategic, analytical, financial, data mining, and operational expertise to clients in the healthcare sector, including health systems, payors, and life sciences companies.

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 ensure appropriate reimbursement based on medical record documentation.
• Research and summarize billing, coding, and reimbursement regulations, and articulate complex coding and clinical terminology.
• 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.

Requirements

• Ability to work independently and collaboratively in a fast-paced, multi-tasking environment with a strong attention to detail.
• Excellent communication (written and verbal) and organizational skills.
• Flexibility with respect to assigned tasks and engagements due to challenging deadlines, changing deliverables, and evolving task priorities.
• Strong work ethic, eagerness to learn, and motivation to succeed.
• Strong critical thinking, problem-solving, analytical, and presentation skills.
• Bachelor’s Degree.
• Current/active coding certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), and/or Certified Outpatient Coder (COC).
• 10+ years of total working experience, 8+ years in medical coding or clinical documentation improvement.
• Proficient use of grouper software and/or coding reference books, and proficiency in using EMR’s such as EPIC, Cerner, Athena, AdvancedMD.
• Basic computer skills, including proficiency in Microsoft Office Suite.

Qualifications

• 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.

Preferred Qualifications

• Knowledge of testifying, mediation, or arbitration experience.
• Demonstrated experience in auditing and monitoring.