RN - Senior Consultant

Myers and Stauffer LC – Richmond, VA

Myers and Stauffer LC is a certified public accounting and health care reimbursement consulting firm. We specialize in providing audit, accounting, data management and consulting services to government-sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare and Medicaid Services). We operate 18 offices nationwide and have approximately 800 associates. We have 40 years of experience assisting our government clients with complex health care reimbursement and provider compliance issues.

At Myers and Stauffer you will have a career that is rewarding on every level of the organization. We are committed to providing our employees with:

• Professional growth and development opportunities
  • Educational opportunities leading to certifications
  • A diverse, dynamic, and challenging work environment
  • Strong leadership, communication, and feedback
  • A well-balanced lifestyle, that includes personal and family time in addition to professional and networking opportunities
  • Creative and innovative solutions to challenges facing our government clients
  • The Nurse - Healthcare Senior Consultant will independently review/audit various claims, medical records and program compliance relating to Medicaid and Medicare engagements.

    Essential Functions:

  • Develop and maintain general knowledge of reimbursement regulations, provider billing manuals and other Medicaid policies
  • Review hospital in-patient DRG coding for correctness
  • Participate in desk and on-site examinations of Medicaid providers to review clinical documentation
  • Interpret and analyze health care data
  • Utilize 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
  • Utilize InterQual clinical decision support for medical necessity review
  • Document and report findings of reviews and audits in accordance with professional standards and project protocols
  • Prepare concise and well-written reports, memos, and proposals
  • Lead meetings, team projects, and discuss current topics with clients
  • Maintain security of and confidentiality of all protected health information
  • Perform additional assignments relating to Medicaid reimbursement and Medicare compliance
  • Participate in and contribute to the quality management system
  • A high level of dependability and accountability to meet predefined production and quality standards
  • Organized approach to work and the ability to function at a high degree of independence, urgency, accuracy, thoroughness and attention to detail
  • Additional responsibilities as assigned
  • Requirements:

  • Bachelor’s degree in Nursing required (Associate’s Degree from accredited nursing school with 4 or more years of additional clinical experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing
  • Licensed Registered Nurse with a current Virginia license
  • Minimum 3 years of clinical review experience with utilization management, case management, or health care claims auditing experience
  • Certified Professional / Hospital Coder Certification (CPC, CIC, COC, CPMA, CCS, CCS-P, RHIA, RHIT ) preferred or proof that certification has been obtained within 12 months
  • Working knowledge and experience in detecting and investigating health insurance fraud, waste, and abuse preferred
  • Working knowledge with healthcare coding principles to include ICD-9, ICD-10, CPT, HCPCS, RUGS, and DRG
  • Experience and knowledge of State and Federal healthcare regulations
  • Knowledge of Medicaid reimbursement and coverage policies desired
  • Proficient use of applicable software programs, including Microsoft Windows, Word, and Excel
  • Strong analytical and problem solving skills
  • Excellent communication skills including written and verbal. Ability to present to large or small groups required.
  • Ability to work independently under general instructions, self-directed and motivated
  • Ability to manage multiple deadlines and prioritize assignments
  • Ability to work in a team environment
  • Well organized with a high degree of accuracy and attention to detail
  • Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid
  • Equal Opportunity Employer committed to employment of Females, Minorities, Persons with Disabilities and Veterans. An E-Verify Employer. Drug-free workplace.

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