Myers and Stauffer LC is a certified public accounting and health and human services reimbursement consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health and human services 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.
At Myers and Stauffer, you will have a career that is rewarding while also supporting our state and federal government health and human services clients that focus on those in need. We are committed to providing our employees with professional growth and development opportunities, a diverse, dynamic, challenging work environment, and a strong and visionary leadership team.
What We Offer:
Health, Dental, and Vision insurance along with other competitive employee benefits
Vacation time, sick time, paid holidays, and two floating holidays
Paid Parental Leave and available support resources
401K with company matching for eligible employees
Tuition reimbursement, referral bonuses, paid volunteer community service time, mentor program, and a variety of other employee programs and perks
A combination of technical and leadership development training at each career milestone
Up to six counseling sessions per year for eligible employees through our Employee Assistance Program
Position Overview:
The Senior Health Care 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.
Essential Functions:
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 in a team environment to develop new audit recovery projects
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
Requirements:
Bachelor's degree required
Minimum three years of clinical documentation review experience, utilization management review experience, or health care claims auditing experience
Knowledge and experience in detecting and investigating health insurance fraud, waste, and abuse
Knowledge of healthcare coding principles to include ICD-9, ICD-10, CPT, HCPCS, RUGS, and DRG
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
Not currently sanctioned or excluded from any program operated by federal or state agencies including Medicare and Medicaid
The Team: Myers and Stauffer takes pride in the welcoming and collaborative culture we have throughout our offices. For this position, the employee will report to one of our Managers or Senior Managers on the Consulting engagement team.
Work Style: Our general business hours are Monday through Friday 8am-5pm, but can vary based on business needs. Dependent on performance, our in-office associates are eligible for a hybrid work schedule after their initial 90-day training period. As a company, we are always willing to discuss potential flexibility that an employee may need to better suit their work-life wellbeing.
Typical Interview Process:
Phone Screen with a Recruiter
In person or remote interview with the hiring manager & team
Hiring decision and job offer
We understand that changing or learning a new industry can discourage strong candidates from applying. Myers and Stauffer is committed to investing in your career development and providing the necessary resources to help you succeed. Please do not hesitate to apply, as you may be the right fit for this position or another position we have open.
