Summary
Position Summary
Regulatory, Risk & Forensic
Our Regulatory, Risk & Forensic team supports client leaders to translate multifaceted risk and an evolving regulatory environment into defensible actions that help strengthen, protect, and transform organizations. Join our team and use advanced data, AI and emerging technologies with industry insights to help client service teams bring clarity from complexity and accelerate their path to value creation.
Position Summary
Level: Consultant
As an experienced Consultant at Deloitte Consulting Services, you will be responsible for individually delivering high quality work products within due timelines. Need-basis you will be mentoring and/or directing junior team members/liaising with onsite/offshore teams to understand the functional requirements.
Work you'll do:
As a Regulatory, Risk & Forensic Operate professional , you will have the opportunity to work on multiple projects leveraging your education and prior work experience to help our clients more confidently make decisions to drive performance. You will help our clients embrace change, grow their business, accelerate performance, and navigate periods of crisis or controversy and emerge resilient.
Role Overview:
Conduct coding and billing compliance reviews on medical records with primary focus on Evaluation and Management (E/M) level of Service validation and Missing Procedures (CPT/HCPCS) review to ensure complete and accurate charge capture prior to billing. The review of the medical documentation is conducted to identify additional missed provider documentation clarifications and/or missed coding opportunities. When discrepancies are identified, updates code as needed and provide detailed rationale and supporting evidence for all recommendations.The professional will utilize the following resources to perform the reviews (not inclusive): The Official Coding Guidelines, ICD-10-CM/PCS, CPT and HCPCs coding guidelines, Federal and State regulations, the American Hospital Association (AHA) coding guidelines including the Coding Clinic and American Medical Association's(AMA) CPT Assistant publications and American Health Information Association (AHIMA) compliant query guidelines.
Outpatient coding reviews
- Performs coding and billing quality reviews on hospital outpatient records to validate the medical record documentation supports appropriate Evaluation and Management (E/M) level selection and CPT/HCPCS reporting (including modifiers, as applicable) prior to billing submission. Responsibilities include, but are not limited to:
- o Outpatient E/M Level of Service Review (99211-99215): Review the encounter documentation (e.g., assessment and plan) and validate that the assigned E/M level is accurate and supported; revise the E/M level when not supported and provide clear, written rationale for the change.
- o Missing Procedure Code Review for various specialties: Review documented services and procedures to confirm complete charge capture; identify missing and/or incorrect CPT/HCPCS codes (and modifiers, as applicable), update coding accordingly, and document supporting rationale. Specialties include (not exhaustive): Dermatology, Ophthalmology, Orthopedics Medicine, Otolaryngology, etc.
- o Identifies missed documentation clarification opportunities and provides appropriate clinical parameters to support compliant documentation queries.
- o Evaluates the appropriateness and compliance of coder-generated clinical documentation queries.
- o Coordinates with downstream stakeholders to ensure corrected coding is routed appropriately and moved forward for billing.
Professional coding reviews
- Performs coding quality reviews on professional encounters to validate that the medical record documentation supports accurate E/M level selection and complete/accurate CPT/HCPCS reporting (including modifiers, as applicable) prior to billing submission. Responsibilities include, but are not limited to:
- o Outpatient E/M level of Service Review (9921199215): Validate that the assigned E/M level is supported by documentation; revise the E/M level when necessary and provide written, detailed rationale and supporting evidence.
- o Missing Procedure Code Review for various specialties: Validate that all documented procedures/services are appropriately captured; identify missing CPT/HCPCS codes (and modifiers, as applicable), correct coding as needed, and document rationale. Specialties include (not exhaustive): Dermatology, Ophthalmology, Orthopedics Medicine, Otolaryngology, etc.
- o Identifies missed documentation clarification opportunities and provides appropriate clinical parameters to support compliant documentation queries.
- o Evaluates the appropriateness and compliance of coder-generated clinical documentation queries.
- o Escalates repeatable coding/documentation themes and supports education/feedback based on review outcomes.
- o Coordinates with downstream stakeholders to ensure corrected coding is routed appropriately and moved forward for billing.
Qualifications
Required Candidate Profile:
- 3-5 years of experience in audit of complex outpatient, hospital outpatient and professional coding and US healthcare claims
- Must hold a coding certification from American Health Information Association (AHIMA) and/or from American Academy of Professional Coders (AAPC) such as a CCS, COC, CPC, CIC etc.
- A graduate from field of medicine or allied healthcare subject is preferred
- Must have experience working on EMR system Epic
- Good understanding of US healthcare
- Demonstrate ability to interact effectively with clients including providers and internal stakeholders
- Must be a dependable and reliable player, able to work independently and as part of a goal-oriented team with a positive attitude
- Must have strong analytical, reasoning and organizational skills
- Experience designing, implementing, and operating risk management and compliance activities
- Prior consulting experience is preferred
- Should have worked on coding and billing domains (i.e. hospital outpatient, emergency department (ED), ambulatory surgery, professional coding, Outpatient etc.)
- In-Depth knowledge of various billing rules OPPS, MPFS etc.
- Thorough knowledge of payment rules hierarchy, fee schedule configuration and their impact on payment
- Superior skills to effectively communicate and negotiate across the business and external health care environment
- Hands-on experience in any of the Encoder tools specific to Hospital coding such as Epic, 3M etc.
Location:
Shift Timings:
- 11 AM to 8 PM or as per business requirements
Our purpose
Deloitte's purpose is to make an impact that matters for our people, clients, and communities. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. Our purpose comes through in our work with clients that enables impact and value in their organizations, as well as through our own investments, commitments, and actions across areas that help drive positive outcomes for our communities.
Our people and culture
Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ways of thinking, ideas and perspectives, and bring more creativity and innovation to help solve our clients most complex challenges. This makes Deloitte one of the most rewarding places to work.
Professional development
At Deloitte, professionals have the opportunity to work with some of the best and discover what works best for them. Here, we prioritize professional growth, offering diverse learning and networking opportunities to help accelerate careers and enhance leadership skills. Our state-of-the-art DU: The Leadership Center in India, located in Hyderabad, represents a tangible symbol of our commitment to the holistic growth and development of our people. Explore DU: The Leadership Center in India .
Benefits To Help You Thrive
At Deloitte, we know that great people make a great organization. Our comprehensive rewards program helps us deliver a distinctly Deloitte experience that helps that empowers our professionals to thrive mentally, physically, and financiallyand live their purpose. To support our professionals and their loved ones, we offer a broad range of benefits. Eligibility requirements may be based on role, tenure, type of employment and/ or other criteria. Learn more about what working at Deloitte can mean for you.
Recruiting tips
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Requisition code: 322999
