Are you looking to join an organization that is growing and dynamic? What about a high-energy, collaborative environment that rewards hard work?

J.S. Held is a global consulting firm that combines technical, scientific, financial, and strategic expertise to advise clients seeking to realize value and mitigate risk. Our professionals serve as trusted advisors to organizations facing high stakes matters demanding urgent attention, staunch integrity, proven experience, clear-cut analysis, and an understanding of both tangible and intangible assets.

The firm provides a comprehensive suite of services, products, and data that enable clients to navigate complex, contentious, and often catastrophic situations.

We are seeking a Forensic Medical Coding & Billing Specialist to join our Medical Records and Billing team. This is a unique opportunity for an entrepreneurial, highly driven person with a well-rounded skill set to join the Medical Records and Billing team, whose responsibilities extend beyond those of traditional Forensic Medical Coding & Billing Specialist. The ideal person for this role will need to not only have a strong grasp of medical records and billing but also be flexible and a strategic thinker able to take on a variety of tasks. 

Key Responsibilities:

1. Forensic Review:
   1. Conduct comprehensive forensic examinations of medical records, bills, and associated documents to identify inaccuracies, misrepresentations, or instances of fraud.
   2. Evaluate and interpret CPT, ICD, HCPCS, and other relevant coding systems to pinpoint discrepancies or inaccuracies.
   3. Understand and navigate EHR systems and billing software. Assist with internal or external audits regarding billing and documentation.
2. Legal Testimony:
   1. Serve as an expert witness in legal proceedings, providing clear, accurate, and authoritative testimony on medical coding, billing, Medicare allowances, UCR (Usual, Customary, and Reasonable) rates, EHR platforms and healthcare compliance matters.
   2. Prepare comprehensive reports and documentation to support legal findings.
3. Documentation & Reporting:
   1. Document findings clearly and concisely, generating reports detailing discrepancies, overcharges, or suspected fraud.
   2. Collaborate with legal and compliance teams, providing them with detailed evidence and data-backed insight for potential legal proceedings.
4. Compliance & Best Practices:
   1. Stay updated on the latest medical coding and billing regulations, ensuring all analyses align with current standards and best practices.
   2. Advise medical and administrative teams on compliance requirements and potential areas of risk.
5. Collaboration & Consultation:
   1. Work closely with healthcare providers, insurance companies, and legal entities to provide expertise on medical billing and coding matters, UCR rates, proper documentation and methodology.
   2. Serve as a consultant to payer sources and attorneys, offering guidance on best practices and potential areas of improvement.
6. Continued Education:
   1. Attend workshops, conferences, and training sessions to stay current on the latest trends and developments in the forensic medical billing and coding field. 
      1. Maintain relevant certifications and pursue additional qualifications as necessary.

Required Qualifications

• Bachelor's degree, Medical Coding, or a related field.
• Certification in Medical Coding, such as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist), BCSC (Billing coding Specialist Certification), Certified Professional Medical Auditor (CPMA) or CMRS (Certified Medical Reimbursement Specialist (CMRS).

• Higher level coding and billing certifications

• Minimum of 5 years of experience in medical billing and coding, with a focus on forensic analysis and insurance claims analysis.
• In-depth understanding of healthcare billing processes, insurance claims, and regulatory guidelines.
• Exceptional attention to detail and analytical skills.

 Preferred Qualifications

• Experience in detecting fraud or discrepancies.
• Masters Degree in Health Science,
• Familiarity with legal processes and protocols related to healthcare fraud.
• Strong written and verbal communication skills, with the ability to convey complex information clearly.
• Proficiency in using medical billing software and related technologies.

Physical and Mental Qualifications

• Prolonged periods sitting and working at a computer

Additional Information

Some of the Benefits We Have Include

J.S. Held understands all our employees are people and sometimes life needs flexibility. We work to always provide an environment that best supports and suits our team’s needs.

• Our flexible work environment allows employees to work remotely, when needed
• Flexible Time Off policy
• Medical, Dental, and Vision Insurance
• 401k Match
• Commuter Benefit

A reasonable estimate of the salary range for this role is $100k - $110k. Any offered salary range is based on a wide array of factors including but not limited to skillset, experience, training, location, scope of role, management responsibility, etc.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

By submitting your application, you acknowledge that you have read the J.S. Held Online Privacy Notice and hereby freely and unambiguously give informed consent to the collection, processing, use, and storage of your personal information as required and described therein. California residents can click here to learn more about the personal information we collect and here to learn about additional privacy rights that may be available.

Please explore what we’re all about at www.jsheld.com.

EEO and Job Accommodations

We embrace diversity and our commitment to building a team and environment that fosters professional and personal enrichment is unwavering. 

J.S. Held is an equal opportunity employer. Qualified applicants are considered for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

If you are an individual with a disability and would like to request a reasonable accommodation during the recruitment process, please email [email protected]. Include "Applicant Accommodation" in the subject line, along with your request and contact information.

All your information will be kept confidential according to EEO guidelines.