Description
Myers and Stauffer LC is a certified public accounting and health care reimbursement consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare & Medicaid Services). We have 45+ years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 20 offices and have over 900 associates nationwide.
Job Summary
The Health Care Senior Consultant will independently review/audit medical records associated with claims and work in a team environment on fraud, waste and abuse and program compliance issues for engagements with government healthcare programs, including primarily the Medicaid and Medicare programs.
Roles and Responsibilities
- Utilizing healthcare knowledge and experience to review medical records for various types of medical services for accuracy, completeness and consistency with professional standards and compliance with billing and coding requirements.
- Documenting and reporting findings of reviews and audits in accordance with professional standards and project protocols.
- Participating in on-site field examinations of providers to review clinical documentation.
- Interpreting and analyzing health care data.
- Working with state client personnel on health care reimbursement and compliance issues, including recommending changes and improvements of policies to ensure provider compliance.
- Working collaboratively with the medical director and other clinical staff in the development and management of fraud, waste and abuse detection and other compliance projects.
- Developing and maintaining general knowledge of reimbursement regulations, provider billing manuals and other Medicaid policies for claim payment compliance reviews and documentation to support current audit findings.
- Maintaining security of and confidentiality of all protected health information (PHI).
- Participating in and contributing to quality management systems
- Additional responsibilities as assigned.
Qualifications and Experience
- Bachelor’s degree in related field preferred or equivalent experience
- At least 3 years’ of related experience required.
- Certification preferred.
- Experience and knowledge of state and federal healthcare regulations, including reimbursement and coverage policies.
- Experience in quality improvement projects desired.
- Proficient use of applicable software tools, including Microsoft Windows, Word, Excel, and Access.
- Strong analytical and problem solving skills.
- Excellent communication skills including written and verbal, including ability to present to large or small groups.
- Self-directed and motivated, with ability to work independently under general instructions.
- Ability to work in a team environment and manage multiple deadlines and prioritize assignments.
- Well organized with a high degree of accuracy and attention to detail
- Must be able to travel based on client and business needs.
