Health Care Disputes - Compliance Risk Adjustment, Senior Director - Senior Director

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

Ankura’s Disputes & Economics professionals are world class and globally recognized independent experts who tailor financial, operational, and compliance solutions to complex litigation, enforcement, and regulatory challenges.

Role Overview

The Senior Director will support the Healthcare Payer team within Ankura’s Disputes & Economics practice - one of seven practices focused on client delivery services across the Firm. This role will use relevant expertise, regulatory knowledge, data analytics skills and project management capabilities to deliver valued client service and deliverables based upon their unique needs and the scope of the project for which we are retained.  This might include the development of custom solutions for clients requiring proactive or reactive support for compliance, accreditations, operations, investigations, and/or litigation/dispute matters generally focused on Medicare and Commercial Risk Adjustment.

The Senior Director will also support practice and firmwide business development activities and initiatives and will be required to participate and support revenue generation opportunities.  They will also have oversight and management responsibilities for downline professionals including Directors, Senior Associates and Associates.  They may be assigned as Performance Managers for these subordinate professionals and will support Ankura’s People Office and D&E practice management with human resource support.

Responsibilities:

The successful candidate would be assigned to various projects where he/she would perform the following types of activities:  

• Help clients manage proactive and reactive Medicare and Commercial Risk Adjustment compliance, audit, and investigation projects for clients.

• Oversee and conduct data gathering activities, document review, and quality control of data assessment.

• Work with Senior Managing Directors and Managing Directors to develop thought leadership, participate in industry conferences and events, and assist with proposal and business development efforts.

• Mentor, supervise and motivate a team of associates, senior associates, and director professionals.

• Prepare client communications, both written and oral, for senior level review.

• Perform client facing tasks including operational, compliance or regulatory assessments and develop associated deliverables.

• Develop and draft proposals, RFP responses and other business development material for the acquisition of client engagements and be active in the sales process with Managing Directors and Senior Managing Directors of the D&E practice.

• Work directly with Managing Directors and Senior Managing Directors in the development of practice initiatives and educational material for internal meetings and events.

• Perform research and interpret emerging and changing regulatory requirements impacting our clients and be able to develop materials that address the same.

Required Qualifications: 

• Bachelor’s and/or master’s degree from an accredited college/university

• 8+ years of experience in Medicare Risk Adjustment operations, internal audit, or compliance either within industry or similar work related work in a consulting firm including a Big 4 or other recognized organization.

• Robust understanding of the operational, compliance, and business issues that affect a healthcare organization, especially related to Medicare and Commercial Risk Adjustment.

• Strong time management skills and ability to manage multiple concurrent projects.

• Commitment to quality and working within a team.

• Effective oral and written communication skills; and,

• Ability and willingness to travel.

• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Preferred Qualifications:

• Specific experience with RADV Audit responses including managing the collection of medical records, overseeing the selection of records and submitting the records to the client.  In addition to RADV audit experience, experience with Risk Adjustment chase list creation, Risk Adjustment vendor audit processes, managing retrospective or prospective Risk Adjustment activities such as Chart Review or In-Home Risk Assessments.

• Knowledge of Risk Adjustment data collection and submission activities as well as knowledge of Risk Adjustment coding requirements preferably with a Risk Adjustment Coder certification.

For individuals assigned and/or hired to work in California, Colorado, or New York, Ankura is required to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the said markets and considers a broad range of factors including but not limited to skill sets, experience and training, licensure and certifications, and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled.  The range does not include additional benefits outside of salary. At Ankura, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each role. A reasonable estimate of the current base pay range is between $85,000 to $200,000; this range is not a promise of a particular wage.

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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 [email protected] 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.