Director, Risk Adjustment
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The Permanente Federation LLC (the Federation/TPF) is the national leadership and consulting organization for the eight Permanente Medical Groups (PMGs), which, together with the Kaiser Foundation Health Plans (KFHP) and Kaiser Foundation Hospitals (KFH), comprise Kaiser Permanente. The PMGs employ almost 23,000 physicians, approximately 90,000 nurses, other clinicians and staff, and provide care to over 12.2 million Kaiser Permanente members. The Federation works on behalf of the PMGs to optimize care delivery and advance Permanente Medicine – medicine that is patient centered, evidence based, technology enabled, culturally responsive, team delivered, and physician led. The Federation, based in Oakland, California, is dedicated to serving and leading Permanente Medicine, the Permanente Medical Groups, and Kaiser Permanente in support of our patients and members.
The people-of The Permanente Federation support each other in-creating an equitable, diverse, and inclusive culture. We-strive to be empathetic in our interactions with each other-and-learn-from-our-mistakes.
We are committed to strengthening-our impact by-representing-the diverse population of patients and physicians we serve while-upholding a culture of fairness and acceptance.
This position is responsible for overseeing a wide range of risk adjustment-related initiatives, including identifying and following through on opportunities to improve the completeness and accuracy of risk-adjusted data submissions to the Health Plan. In partnership with Kaiser Permanente Hospitals and Health Plan, the incumbent is responsible for advancing operations needed to ensure applicable alignment between Permanente Medical Group (PMG) and National risk adjustment functional teams (including but not limited to Revenue Management Compliance, Legal, Risk Adjustment Data and Analytics, Revenue Cycle, KP Insight, and Information Technology) to forward initiatives and resolve issues.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
oProvides support to PMGs regarding risk adjustment operations (Medicare, Medicaid, HealthCare Reform, Commercial risk adjustment).
oCollaborates with Health Plan leadership to ensure PMGs clearly understand risk adjustment payer requirements.
oWorks with PMGs and Health Plan to assess internal practices, make recommendations, develop/adjust strategy, and meet changing business and regulatory conditions.
oProvides support to Co-Chairs of the Clinical Documentation Reporting Group (CDRG), a venue to share PMG and regional successful practices, learnings, and regulatory changes.
oPartners with Government Relations, Legal, Revenue Management Compliance, Risk Adjustment Data and Analytics, Revenue Management, KP Insight, Actuarial Services, Information Technology/ KP HealthConnect, and other organizational functional areas to ensure a comprehensive review of regulatory changes or new policies in the risk adjustment space and understanding associated impacts to KP business and PMG clinical operations.
oEnsures applicable functions are informed of new requirements impacting internal systems to incorporate changes necessitated by Medicare, Commercial, and ACA reimbursement policy and regulatory changes.
oActively engages with PMGs to determine strategies, priorities, and investment for infrastructure and support for risk-adjusted programs.
oUnderstand industry-leading practices and drive continuous improvement in internal approaches, methods, and tools and organizational awareness of industry-leading capabilities.
· Extensive knowledge of the multi-specialty group practice model. Knowledge of Health Plan, clinic and hospital operations required
· Proven success in enterprise-level leadership, including experience in implementing large-scale change
· Deep knowledge and expertise in health information and payment policy for risk adjustment
· Strong knowledge of Federal rules and regulations regarding documentation, coding, and risk adjustment
· Ability to work independently to further the vision of The Permanente Federation, the Permanente Medical Groups, and Kaiser Permanente as a whole
· Demonstrated ability to lead and manage a cross-functional team
· Exceptional analytic, conceptual, and business planning skills
· A proven track record of results in working with process management
· Demonstrated ability to work effectively with physicians and other professional leaders through influence and collaboration
· Demonstrated experience in successfully managing complex organizational initiatives and change efforts in matrixed organizations
· Superior communication, consulting, facilitation, negotiation, conflict management, problem resolution, and consensus-building skills
· Excellent written/verbal presentation and listening skills, and the ability to present complex information clearly and concisely to a variety of audiences
· Proven ability to provide professional/technical guidance to stakeholders
· Demonstrated ability to foster a culture of innovation
MINIMUM EDUCATION AND/OR EXPERIENCE:
• Bachelor's degree in Health Care Administration, Business, Health Information Management, or a related field required (or equivalent experience).
• Master's degree preferred.
• Minimum ten (10) years of progressive professional experience in risk adjustment documentation and coding operations or related fields, including five (5) years of program management experience.
• Excellent communication and organizational skills with keen attention to detail
• Advanced problem-solving skills
• Advanced proficiency in Microsoft Office applications.
TRAVEL & JOB LOCATION:
• The position is remote
• Travel as required (approximately 10% of the time)
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest