Senior Director, Health Care Disputes (Coding & Compliance)

Ankura is a team of excellence founded on innovation and growth.

Ankura’s Health Care Disputes and Life Sciences Practice advise outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. 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 subject’s protection, and financial fraud related to research. Our practice is often called upon to advise investors on operational and compliance matters in the course of due diligence. We serve as the Independent Review Organization 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. This role is location agnostic and may be remote.

Responsibilities:

• Proficient in medical coding, billing, and documentation requirements

• Works with the Project Manager to analyze and understand client concerns and develop project work plans as requested

• Understands health care compliance concepts, issues, and how to research and access regulatory guidelines and reference materials

• Conducts independent review of medical records - EMR or paper documentation

• Drafts clear and concise analyses of medical record review findings 

• 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

• Proven writing and presentation skills

• Communicates findings of concern with the team and Project Manager as they are identified

• Utilizes creative problem-solving techniques

Qualifications:

• Associate or bachelor’s degree preferred from an accredited college/university

• Current Coding Certification through either AAPC or AHIMA

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

• Clinical experience is a plus

• Demonstrates excellent communication skills, both written and oral

• Experience managing small projects and teams

• 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

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.