Senior Health Care Consultant

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.

At Myers and Stauffer, you will have a career that is rewarding while also supporting our state and federal government healthcare 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 Health Care Senior Consultant will independently and, in collaboration with audit teams, conduct compliance audits in accordance with protocols published by the Centers for Medicare and Medicaid (CMS). Additionally, considered candidates will perform reviews of medical documentation submitted by Medicaid providers including physicians, hospitals, nursing facilities, pharmacies, behavioral health facilities, home and community-based agencies, therapists, etc. The reviews will assess the documentation's accuracy, completeness and compliance with applicable standards. The reviews will be documented according to established protocols to support findings.

Essential Functions:

• Develop and maintain knowledge of CMS Managed Care and Program for All Inclusive Care of the Elderly (PACE) regulations and guidance.
• Utilize healthcare knowledge and experience to conduct compliance audits via document reviews, desk review and/or webinars, consistent with applicable CMS audit protocols and methods of evaluation.
• Utilize healthcare knowledge and experience to conduct and document on-site observations of participant care, as assigned.
• 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, as needed or assigned.
• Work collaboratively with the audit team, Audit Lead, and leadership to complete contract deliverables defined in the Statement of Work.
• Work collaboratively with State Administering Agency (SAA) representatives, as needed, during the audit.
• Maintain client contact, communication, and meetings, developing rapport and enhancing business relationships.
• Lead meetings, team projects, and discuss current topics with clients, as assigned.
• Perform additional assignments relating to Medicare compliance engagements.
• Participate in and contribute to the quality management system.
• Perform various assignments relating to Medicaid reimbursement.
• Review medical records for accuracy, completeness and consistency with professional standards.
• Work closely with accounting staff and state client personnel on health care reimbursement related issues.
• Develop and maintain general knowledge of Medicaid statutes, regulations, provider billing manuals and other Medicaid policies.
• Interpret and analyze health care data.
• Written and verbal communication skills necessary to successfully interact with accounting staff, state agency staff and providers in a professional manner, developing rapport and enhancing business relationships.
• Exhibit a high level of dependability and accountability to meet predefined production and quality standards.
• Exhibit an organized approach to work and the ability to function at a high degree of independence, urgency, accuracy, thoroughness and attention to detail. Assume additional responsibilities and duties, as assigned.
• Maintain security of and confidentiality of all protected health information.

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.
• Minimum 3 years of clinical review experience with utilization management, case management, or health care claims auditing experience preferred. Diversity of clinical experience including inpatient hospital setting, critical
• care areas, and outpatient hospital clinics considered.
• Experience and knowledge of State and Federal healthcare regulations preferred.
• Proficient use of applicable software programs, including Microsoft Windows, Word, and Excel.
• Strong analytical and problem solving skills.
• Excellent written and verbal communication skills. 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.
• May require travel out of town 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 Managed Care 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.