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Coding Compliance Director

Location: Oakland, California;

Job ID : 3487676


The Coding Compliance Director is responsible for directing the implementation of an effective compliance program to ensure compliance with state and federal laws and regulations, as well as Kaiser Foundation Health Plan (KFHP) and Kaiser Foundation Hospital (KFH) policies and procedures, relating to clinical coding for all lines of business and all clinical services. This position reports directly to the VP, Government Audit and Reimbursement Compliance Services.

The Coding Compliance Director supports the enterprise with identifying, investigating, and resolving all compliance matters relating to medical coding that could impact risk adjustment, encounter reporting, and /or reimbursement activities for KFHP and/or KFH.

This position is responsible for directing the Coding Compliance team. The Director ensures that Coding resources are staffed sufficiently and annual work plans managed to effectively address the organization-s coding compliance priorities and primary risk areas. This requires extensive coordination with the National Finance leaders, as well as the KP Health Connect teams, Internal Audit Services department, the NCO senior leadership team, KFHP Legal, quality teams, Health Information Management teams, benefits teams, government relations, and the regional and hospital compliance functions.

Essential Functions:
- Personnel Management: Manages the efforts of direct reporting, as well as matrix reporting, positions. Responsible for selecting, developing, and deploying personnel in the most effective manner to meet objectives. Responsible for performance management, compensation decisions, and providing on-going, regular developmental feedback. Influences performance management, compensation decisions, and ongoing feedback for individual contributors reporting to direct report managers, possibly through more than one layer of subordinate management.
- Communications, Stakeholder Management, and Negotiation of Agreement: Facilitates communications, manages relationships with stakeholders, and garners support and agreement from involved parties for compliance initiatives and programs for functional areas across the enterprise.
- Issue Management, Response, and Mitigation: Responsible for issue management, response, and mitigation for functional areas across the enterprise. Proactively identifies risks and issues related to projects and production operations. Anticipates and addresses issues through regular communication with reporting positions and other internal and external parties at all levels, mitigating risk or, in the most severe cases, escalating issues for resolution by more senior levels as necessary.
- Change Management: Responsible for leading change management efforts for functional areas across the enterprise. Identifies and acts upon opportunities to leverage direct reporting team in change management activities; ensures direct reporting team is engaged in change management as appropriate.
- Project Management: Responsible for management of project plans for objectives or projects for functional areas across the enterprise as well as ensuring project timelines and objectives are met for projects managed by reporting positions.
- Strategic development: Participates in the identification and development of objectives, goals, and strategy relative to functional areas across the enterprise.

-Participates as a member of the National Compliance Office (NCO) Team Leader group in the development, implementation, monitoring and completion of NCO-s strategic plan.
-Ensures successful collaboration with the Permanente Federation and Permanente Medical Groups to support activities that ensure accurate and complete coding.
-Directs and demonstrates coordination with the Regional Compliance Officers to ensure that the coding compliance function is effective in the regions in partnership with National Compliance efforts.
-Directs the identification and mitigation of revenue cycle coding compliance risk associated with billing, risk adjustment, encounter reporting, and reimbursement for all lines of business.
-Directs an effective coding compliance monitoring program for risk adjustment and encounter reporting activities across all lines of business. Responsible for developing and delivering services to a national chart review function, which will be tasked with performing independent monitoring for coding accuracy. Will lead the investigation of coding discrepancies identified in reviews to determine the causes of discrepancies.
-Directs the process for monitoring new regulations and sub-regulatory requirements that impact medical services coding. On an on-going basis, oversees the researching and interpretation of regulations and laws to establish coding compliance standards, and may direct the development and/or delivery of coding training and coding communications/change management relative to new standards. Collaborates with relevant stakeholders across all government lines of business to ensure appropriate implementation and compliance.
-Provides external government audit support, coordination, and trend analysis in the areas of coding compliance in partnership with Government Audit Services. This includes Risk Adjustment Data Validation, the Commercial encounter data validation, RAC audits, and any other audits of reimbursement.
-The Director will partner with compliance peers to ensure remediation of potential data submission errors and claims made in error and develop education regarding trends identified. May direct the investigation of violations of compliance policy, laws, regulations, etc. or on-going monitoring and reporting to ensure remediation.
-The Director will also partner with compliance peers in the creation of an annual coding compliance plan and the development of coding and compliance policies, procedures and processes. Accountable for brokering agreements and gaining support for coding compliance initiatives from decision makers at all levels. May be responsible for project management relative to new coding related compliance, ethics and integrity initiatives, products, or annual processes.
-Ensures that the Coding Compliance team contributes effectively to the Reimbursement Compliance Groups designed to deliver reimbursement, coding, and clinical compliance requirements collectively to care delivery communities of practice.
-Create and implement an effective compliance program that supports the enterprise-wide revenue cycle and government reimbursement operations, as described above and, including:
- Providing compliance leadership support to the Revenue Cycle executive leadership team, as well as the Finance team, the Finance Compliance Committee, and any Health Plan reimbursement leadership forums.
-Serve as a subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations.
-Conduct enterprise risk assessments of potential and detected coding compliance deficiencies.
-Ensuring appropriate training and awareness of coding / revenue cycle compliance risk.
-Partnering with revenue cycle stakeholders to create and implement coding revenue cycle compliance policies and procedures.

Qualifications: Basic Qualifications:
- Minimum five (5) years of management experience.
- Minimum twelve (12) years of compliance-related experience.
- Bachelor's or clinical degree, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A.

Additional Requirements:
- Expert knowledge of compliance policies, practices and systems.
- Develops advanced compliance principles, theories, and concepts.
- Expert knowledge of compliance-related practices and standards.
- Project management skills.
- Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:
-Bachelor-s degree in related field (Health Care, Business, etc.) Master degree preferred. Significant revenue cycle compliance experience preferred.
- 10+ years of escalating managerial work-experience in a highly diversified organization (KP experience preferred)
-5+ years of escalating responsibility and work-experience in compliance field (internal audit, compliance, etc.); to include progressive management roles in large, complex organization with successive levels of accountability and results.
-Significant compliance orientation, coupled with business process expertise and acumen. Demonstrated knowledge of current thinking and practice around the business of compliance.
-Significant knowledge of all pertinent regulatory requirements and compliance program elements
-Demonstrated ability to collaborate, communicate and work effectively with senior leadership and a broad cross section of management/leadership from a broad range of functional areas. Demonstrated ability to influence and motivate interdisciplinary teams and individuals who do not report directly to the CCO.
-Demonstrated strength in organizational development, project management, and strategic planning.
-Superior communications skills (both oral and written)
-Demonstrated high ethics and integrity
-This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanente-s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and Kaiser Permanente-s policies and procedures.

Primary Location:California,Oakland,Ordway One Kaiser Plaza

Scheduled Hours (1-40):40


Working Days:Mon-Fri


Job Type:Standard

Employee Status:Regular

Employee Group:Salaried, Non-Union, Exempt

Job Level:Manager with Direct Reports

Job:External Affairs / Relations

Public Department Name:National Compliance, Ethics, & Integrity

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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