BerryDunn is seeking a Senior Consultant to join our Healthcare Group as a member of the Healthcare Compliance Practice Area. You will join a core team tasked with assisting the firm’s clients with clinical documentation improvement, revenue integrity efforts, regulatory research, and general coding and billing compliance in a multitude of healthcare settings. This role involves complex audit reviews, provider education, and data-driven analysis to identify trends, mitigate risk, and optimize revenue integrity. This position is planned to sit remotely. The ideal candidate for this position will possess both a clinical and coding / auditing background with experience in both inpatient DRG/APR-DRG, and professional services CPT and ICD-10 coding.

• Perform comprehensive audits of facility and outpatient/professional claims for coding accuracy (i.e. CPT, HCPCS, ICD-10-CM/PCS, DRG, APC, and E/M levels)
• Review clinical documentation and coding to ensure compliance with relevant payer policies, as well as applicable Federal and State regulations and coding guidelines.
• Conduct education sessions for physicians and other qualified healthcare practitioners based on results of clinical documentation reviews
• Review billing practices for facilities and practitioners across the continuum of care.
• Perform independent research, assessment and remain current with CMS, NGS Medicare, and Office of Inspector General (OIG) regulations, guidelines, bulletins, coding practices & methods, annual, semi-annual, and quarterly coding updates and other publications for impact on Institutional services. Monitor daily notifications and listservs such as CMS, Medicare, NGS, AHIMA, etc., and third-party payers for updates and changes in regulations and professional and peer organizations/practices/policies/guidelines to keep current with regulatory requirements and accepted compliance and audit practices.
• Analyze paid claims data reports and develop risk informed audit plans.
• Assist with development, review, and maintenance of compliance-related policies, procedures, and workplans.
• Identify, assess, and escalate potential compliance risks, including billing, documentation, privacy, and regulatory concerns.
• Assist clients with regulatory inquiries and payer reviews and participate in special compliance projects (e.g., external audit response, RAC review).
• Analyze large data sets from EMR, billing systems, and audit tools to identify patterns, outliers, and compliance risks.
• Develop dashboards and reports to present audit findings, trends, and actionable insights to leadership and compliance officers.
• Recommend actionable improvements to policies, workflows, and coder/provider performance
• Remain current with changing compliance and audit issues through ongoing education and outreach efforts. 
• Safeguard Protected Health Information (PHI) through adherence to HIPAA privacy and security standards in all documentation and communication
• Perform other duties as assigned.

Experience (required):

• Minimum 3-years recent experience of MS-DRG, AP-DRG and APR-DRG, professional and outpatient CPT and ICD-10 coding/auditing with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
• Experience in developing and providing audit outcomes to practitioners and staff
• Skilled in applying the official coding guidelines, coding clinic determinations and CMS and other payer and regulatory compliance guidance. Requires expert coding knowledge - DRG, APR-DRG, ICD-10, CPT, HCPCS.
• Demonstrable Proficiency in using Word, Outlook, Excel, and PowerPoint
• Excellent written and verbal communication skills

Qualifications:

• One or more nationally recognized inpatient coding compliance certification (i.e. AHIMA CCS, AAPC CIC) and professional coding certification (i.e. AAPC CPC) required
• Bachelors degree, RN/LPN or other clinical credential, and/or clinical documentation improvement certification preferred
• 3 years’ minimum relevant healthcare experience is required including specialized skills in compliance related activities
• Ability to work independently, as well as in a team setting
• Exceptional flexibility, organization and time management skills to manage priorities and deadlines
• Adeptness in regulatory research related to clinical documentation and compliance

 Technical Skills:

• Prior experience using Electronic Health Record systems (Epic, Cerner, Meditech)
• Ability to develop clinical documentation and coding audit tools
• Understanding of sampling and basic data analytics (Pivot Tables).

Soft Skills:

• Strong analytical thinking, detail orientation, excellent communication, and the ability to influence clinical staff.
• Capable of working independently and leading post-review and compliance education initiatives.
• Exhibits honesty and resilience in dynamic environments, embracing change and proactively seeking clarification when needed.

The base salary range targeted for this role is $100,000 - $125,000. This salary range represents BerryDunn’s good faith and reasonable estimate of the range of possible compensation at the time of posting. If an applicant possesses experience, education, or other qualifications more than the minimum requirements for this posting, that applicant is encouraged to apply, and a final salary range may then be based on those additional qualifications; compensation decisions are dependent on the facts and circumstances of each case. The salary of the finalist selected for this role will be based on a variety of factors, including but not limited to, years of experience, depth of experience, seniority, merit, education, training, amount of travel, and other relevant business considerations.

Our people are what make BerryDunn special, and in return we strive to support our employees and help them thrive. Eligible employees have access to benefits that go beyond what’s expected to support their physical, mental, career, social, and financial well-being. Visit our website for a complete list of benefits and a look into our culture: Experience BerryDunn.

We will ensure that individuals are provided reasonable accommodation to participate in the job application or interview process or perform essential job functions. Please contact careers@berrydunn.com to request an accommodation.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

About BerryDunn

BerryDunn is the brand name under which Berry, Dunn, McNeil & Parker, LLC and BDMP Assurance, LLP, independently owned entities, provide services. Since 1974, BerryDunn has helped businesses, nonprofits, and government agencies throughout the US and its territories solve their greatest challenges. The firm’s tax, advisory, and consulting services are provided by Berry, Dunn, McNeil & Parker, LLC, and its attest services are provided by BDMP Assurance, LLP, a licensed CPA firm. 

BerryDunn is a client-centered, people-first professional services firm with a mission to empower the meaningful growth of our people, clients, and communities. Led by CEO Sarah Belliveau, the firm has been recognized for its efforts in creating a diverse and inclusive workplace culture, and for its focus on learning, development, and well-being. Learn more at berrydunn.com.

#BD_ATA