Managing Director Business Risk Management Oakland, CA
This position serves as the business risk management leader for revenue cycle operations in the region. The position is responsible for actively monitoring state, and national regulatory trends/changes, assessing both the compliance risk, and the impact of regulatory changes to revenue cycle operations, and advising leadership on the type and timing of responses. The position provides direction on risk management, and compliance issues to key stakeholders ensuring that regulatory requirements are not compromised and that organizational objectives are met. The position serves as an 'independent' compliance monitor to the Revenue Cycle organization to ensure a high level of objectivity and integrity is maintained. The position provides senior leadership in Revenue cycle with an independent review to ensure that a high level of objectivity and integrity is maintained. The position supports health plan, TPMG, and service area leadership, and regional departments (Internal Audit/SOX/Finance, etc.), and regional and national compliance officers on all revenue cycle compliance issues. The position is responsible for coordinating with Regional and National Compliance to create a culture of compliance throughout the revenue cycle organization in which leaders and team members know what is required; have the proper tools, information, training, and support to meet requirements; follow defined procedures; and are recognized for compliant behavior and performance.
Basic Qualifications:
- Bachelor's degree or equivalent experience in Health Care Administration, or Business or Public Health Administration required
- Substantial experience (10+ years) of progressively responsible compliance/regulatory/quality management experience with minimum 3+ years in a senior leadership/executive role.
- Demonstrated ability to determine key business/compliance issues and develop appropriate actions plans from multi-disciplinary perspectives.
- Demonstrated management skills, including working with varied levels of staff through Senior Leadership, budgeting, delegation, staff development, and resource allocation and planning, and performance assessment skills.
- Outstanding communication skills with the ability to communicate persuasively and effectively (written and oral) to a wide range of internal and external customers.
- Demonstrated expertise in project management, analytic problem solving and negotiating.
- Demonstrated ability to lead professionals and manage through influence and collaboration.
- Strong working knowledge of federal and state laws and regulations related to health care and managed care organizations.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Certification in Healthcare Compliance (CHC) preferred.
-Masters, law or related degree strongly preferred.
Qualifications:
Essential Functions:
- works with the VP Revenue Cycle, business and clinical leadership, and regional and national compliance leadership to develop a comprehensive, integrated business risk management/compliance plan and to create a common vision, strategy, and feedback loops for managing business risk within the revenue cycle organization.
- Works with the revenue cycle, business, and clinical leaders to develop and execute on-going strategies and tactics to ensure compliance readiness at all times within all areas of the revenue cycle organization.
- Collaborates with legal, compliance, internal controls, and SOX leaders at the national and regional levels to align regulatory requirements, processes, audit functions, policies, procedures, and strategic initiatives.
- Maintains a working knowledge of relevant third party payer contracts, accreditation standards, and regulatory trends, and industry practices that may impact the revenue cycle organization. Develops strategies to mitigate adverse impacts, and to leverage opportunities with respect to relevant trends, and changes, etc. Works collaboratively with the executive leadership, local leadership and the medical group leadership to integrate these changes into operations.
- Collaborates with regional and national compliance, SOX, quality, and internal audit departments to develop an integrated annual audit plan and directs the revenue cycle internal audit function. Develops programs to monitor, identify, and provide feedback to revenue cycle operational leaders on revenue cycle compliance problems and risks.
- Represents the revenue cycle organization in regulatory review forums/committees providing subject matter expertise on the potential impact of proposed changes in state and federal legislation, accreditation, and regulatory requirements (including health care reform) to the revenue cycle organization.
- Serves as a subject matter expert and advises clinical and business leadership on issues relating to regulatory compliance, health reform, and accreditation standards.
- Monitors state and national trends and regulatory changes in health care delivery. Identifies potential issues/risks to the revenue cycle organization and alerts senior leaders to changes/issues/risks on the horizon.
- Monitors the FAC Org system to ensure a highly level of integrity in all data elements.
- Works collaboratively with the revenue cycle leadership to develop educational programs for regional departments, and service areas to ensure compliance with regulations, accreditation standards, and organizational policies and procedures.
- Develops, and manages a compliance performance dashboard with leading indicators designed to identify areas of risk, and opportunities for improvement and monitors corrective actions designed to ensure compliance mandates are achieved timely; escalates issues; and reports performance to business and clinical leadership.
- Manages operating expenses within budget, and seeks opportunities to improve efficiency and reduce costs.
- Develops and executes an integrated communications plan to effectively engage and inform key stakeholders of relevant changes/updates to regulations, and accreditation standards to ensure success of key business strategies and operating areas.
- Establishes a plan to develop leadership capabilities, and employee engagement within the revenue cycle compliance community and create a culture that achieves high performance and professional integrity.
- Collaborates with the Regional Compliance Office to set strategic direction in responses to regulatory and accrediting agencies on surveys, audits, and incidents of non-compliance, errors, and omissions; communicates issues to appropriate stakeholders, and escalates issues to senior leadership; and works with revenue cycle, and business, and clinical leaders to address/mitigate risks to the organization.
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