Government Reimbursement Compliance Director Oakland, CA
The Government Reimbursement 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 risk adjustment, encounter reporting, billing, and reimbursement activities for all lines of business paid by or overseen by the government. This position reports directly to the VP, Government Audit and Reimbursement Compliance Services.
The Government Reimbursement Compliance Director supports the enterprise with identifying, investigating, and resolving all compliance matters relating to risk adjustment, encounter reporting, and reimbursement activities for KFHP and KFH.
This position is responsible for directing the Government Reimbursement Compliance team. The Director ensures that Government Reimbursement resources are staffed sufficiently and annual work plans managed to effectively address the organization-s government reimbursement compliance priorities and primary risk areas. This requires extensive coordination with the National Finance leaders, as well as the Internal Audit Services department, the NCO senior leadership team, KFHP Legal, SOX PMO, and the regional and hospital compliance 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.
-Directs the identification and mitigation of revenue cycle compliance risk, including billing, risk adjustment, encounter reporting, and reimbursement for all government lines of business, including Medicare Part C, Medicare Part A/B, Medicare Part D, Commercial Individual and Small Groups, Medicaid, Federal Employee Health Benefits Program, and others as relevant.
-Directs an effective compliance monitoring program for risk adjustment and encounter reporting activities across all lines of business.
-Directs the process for monitoring new regulations and sub-regulatory requirements that impact revenue cycle, encounter reporting, risk adjustment, and/ or Medicare Finance operations.
-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 reimbursement 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.
-Ensures successful collaboration with the Permanente Federation and Permanente Medical Groups to support activities that ensure accurate and complete government reimbursement.
-Directs and demonstrates coordination with the Regional Compliance Officers to ensure that the revenue cycle compliance function is effective in the regions in partnership with National Compliance efforts.
-Ensures that the Reimbursement 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, including:
-Providing compliance leadership support to the Revenue Cycle executive leadership team, as well as the Finance team and the Finance Compliance Committee.
-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 compliance deficiencies.
-Ensuring appropriate training and awareness of revenue cycle compliance risk.
-Partnering with revenue cycle stakeholders to create and implement revenue cycle compliance policies and procedures.
-Creating and supporting the implementation of an ongoing monitoring program for billing, coding, encounter reporting and risk adjustment activities in all relevant lines of business (Medicare, Medicaid, ACA, etc.).
-Providing subject-matter expertise and support for all revenue cycle and reimbursement compliance matters and investigations.
-Contributes to the analyses of repayments of government reimbursement.
-Performing ongoing assessments of revenue cycle and reimbursement risk that inform annual work plans to achieve continuous risk mitigation and process improvement for revenue cycle activities.
- 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
- 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.
-Bachelor-s degree in related field (Health Care, Business, etc.) Masters or law 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, law, 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 office
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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