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 of professionals to assist clients and counsel in reviewing medical records to independently evaluate the services provided and compliance with various regulations.
• Examine outpatient, physician office, and inpatient medical records; review principal and secondary diagnoses and procedures, applying strong understanding of clinical documentation and care delivery workflows.
• Validate accuracy of code assignments (ICD-10-CM/PCS, CPT, HCPCS, MS-DRG, HCCs) and confirm appropriate reimbursement based on medical record documentation.
• Research billing, coding, and reimbursement regulations and summarize issues for discussions with client and counsel, citing relevant regulatory sources.
• Articulate complex coding and clinical terminology or ambiguous guidance for internal teams, client 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 which may include coordinating team efforts, review of complex findings, and communication of key insights and recommendations to client executives.
• Provide education to physicians and staff on documentation guidelines.
• Review and revise client policies related to coding and clinical documentation.

Requirements

• Ability to work both independently and as part of a team in a fast-paced, multi-tasking environment with a strong attention to detail.
• Excellent communication (both 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 medical coding or clinical documentation improvement experience preferably in a consulting/professional services environment.
• Proficient use of grouper software and/or coding reference books to determine appropriate code assignment.
• Experience using EMR’s such as EPIC, Cerner, Athena, AdvancedMD.
• Proficient in use Microsoft Office Suite, including Outlook, Word, Excel and PowerPoint.
• Willingness to travel periodically, some travel may be required (up to 30% annually).