Asst Dir Data Quality CDAO (Ed & Trg) Pasadena, CA
The Assistant Director is responsible for the operations of the assigned functional area and the area's compliance with organization and department guidelines and regulations.
Responsible for project management for assigned organizational initiatives, the creation of training materials, organization of the training sessions on subjects complementing organizational and audit operations departmental initiatives, needs, regulation and coding updates.
Builds working relationships with senior managers at the National, Divisional, Regional, Service Area and Medical Center levels for the development of a team environment for consistent application of audit operations directives across the region.
Responsible for partnering with local providers, and other leadership and administrative teams to oversee the quality and accuracy of coded physician professional services clinical and administrative data.
Develops, implements, and manages utilization review and cost containment programs for appropriate areas within the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, TPMG and SCPMG.
Oversees the communication and implementation of organization directives within the assigned functional area and as needed throughout the organization.
Within the functional areas (where appropriate), the Assistant Director provides expertise in ICD-9-CM, ICD-10-CM, hierarchical condition categories (HCCs), CPT (including E&M, diagnostic, and procedural services) as well as federal, state, and organizational compliance guidelines to ensure optimal documentation and compliance.
- Manages the daily operations of assigned functional area and staff.
- Manage and develop staff within the assigned functional area.
- Provide strategic planning and direction to meet organizational initiatives aligning goals and work completed in the department with organizational objectives.
- Lead the hiring process and interviews. Oversee the on-boarding process.
- Prepare and manage budgets and resource allocations.
- Review vendor contracts and make recommendations to the Director.
- Accountable for the implementation and monitoring of SCPMG initiatives within assigned functional area.
- Assure compliance of operational processes and outpatient encounter charge/data capture throughout Southern California Kaiser Permanente making determinations with respect to appropriateness of documentation, adherence to federal, state, and local regulations.
- Identify and create strategies for increasing efficiency and improving processes. Work with leadership to implement approved departmental changes.
- Review policies and procedures to ensure compliance of operational processes and physician professional services charge/data capture throughout Southern California Permanente Medical Group on an annual basis.
- Review mediation on complex coding and compliance issues and analyze problem trends.
- In collaboration with key stakeholders, assess effectiveness of training, and communication tools for coding documentation, questions and provider and auditor feedback.
- Identify trends, patterns, and/or system issues that may contribute to coding and documentation deficiencies and risk areas and make recommendations to Director.
- Join local committees and collaborate with NCO, KPHC, long term support, and champion physician workgroups to resolve local coding issues, ensure compliance with local and regional audit plan, SOX and Corrective Action Plan ('CAP') requirements, and act as communication link regarding changes to federal and state government billing and coding guidelines.
- Bachelors Degree or (seven  years) equivalent experience in Finance/Business, Medical Records Technology, Health Services Administration, or Nursing.
- Masters Degree preferred.
- A minimum offive (5) years ofexperience in a management/supervisory role, last three (3) years need to be in a manager role.
- Proficient in team building, conflict resolution, group interaction, project management, and budget management required.
- Knowledge of CMS rules and regulations and current coding resources, including CPT, ICD-9-CM, ICD-10-CM, HCPCS, fee schedule and HCCs (where appropriate).
- Critical thinking skills and ability to resolve complex issues and perform root cause analysis.
- Strong interpersonal skills, including the ability to establish and maintain effective relationships with providers, leadership, senior administrators, colleagues and auditing staff.
- Excellent communication (written and verbal), presentation, and facilitation skills.
- Must be flexible to meet the needs of the department and/or provider schedule.
- Proficiency in Microsoft Office (Excel, Word, PowerPoint, Access and Visio, etc.).
- Must be available to work flexible days and hours.
- Must be able to travel between all Medical Center facilities if required. Position may include assignment to various Medical Centers and/or regional offices.
- Must be able to work in a Labor/Management Partnership environment.
- Consistently demonstrates the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to customers, contracted providers, and vendors.
- Research skills including knowledge of automated analysis tools and on-line research tools to resolve complex healthcare issues.
- Certification in one or more of the following: Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), and/or Certified Coding Specialist - Physician (CCS-P) is highly desired.
- Specialty coding certification is highly desired.
- Certification in Healthcare Compliance is highly desired.
- Experience in health insurance in billing and charge capture outside Kaiser Permanente is highly desired.
- Medical center operations or clinical experience.
- Experience in adult learning principles in training various content to all levels of staff in small and large group settings.
- Experience in Word, Excel, PowerPoint and Access.
- 10-key KSPM skills.
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