Director, Compliance, Medical Coding

Job description

Job Summary:

In addition to the responsibilities listed below, the position is also responsible for serving as a Risk Adjustment compliance subject matter expert related to coding functions, overseeing audit activity related to coding within all settings of care, ensuring compliance with national coding policies and procedures, ensuring that teams are educated in latest coding developments, and monitoring the accuracy and quality of coding assignments across all lines of business.

Additionally, this position is responsible for approving the annual coding audit plan and ensuring alignment with business objectives, reviewing reports of audit results, setting the direction for coding and focused projects related to audit outcomes, reviewing and approving policies and procedures related to Risk Adjustment, reviewing training materials related to coding policies and procedures, providing coding oversight of the Risk Adjustment Data Validation (RADV) process, and enforcing compliance and the Principles of Responsibility (KP's code of conduct).

Essential Responsibilities:

+ Demonstrates continuous learning and maintains a highly skilled and engaged workforce by aligning resource plans with business objectives; overseeing the recruitment, selection, and development of talent; motivating teams; preparing individuals for growth opportunities and advancement; staying current with industry trends, benchmarks, and best practices; providing guidance when difficult decisions need to be made; and ensuring performance management guidelines and expectations drive business needs.

+ Oversees the operation of multiple units and/or departments by identifying customer and operational needs; analyzing resources, costs, and forecasts and incorporating them into business plans; gaining cross-functional support for business plans and priorities; translating business strategy into actionable business requirements; obtaining and distributing resources; setting standards and measuring progress; removing obstacles that impact performance; guiding performance and developing contingency plans accordingly; and ensuring products and/or services meet customer requirements and expectations while aligning with organizational strategies.

+ Oversees company compliance activities by ensuring team members, including external business partners, provide support to internal and external stakeholders; reviewing and approving compliance activities; designing strategies for the implementation of regulations and regulatory changes; ensuring compliance activities are fully documented; and overseeing the resolution of compliance issues.

+ Directs compliance reporting efforts across multiple business functions by overseeing the evaluation and summary of compliance data, audit information, and potential risks and remedies; identifying and reporting key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations) to senior management; and developing complex presentations to convey key findings to executive leadership and external business stakeholders.

+ Directs compliance investigations across multiple business functions by overseeing the collection and analysis of quantitative and qualitative data; conducting interviews on escalated issues as appropriate; reviewing and evaluating research on key business issues; and evaluating and recommending corrective action plans for substantiated allegations.

+ Directs programs or compliance components of larger cross-functional programs by identifying and managing stakeholder contacts; assembling teams based on program needs and team member strengths; developing, analyzing, and managing program plans; negotiating and managing program schedules and resource forecasts; and managing program financials and deliverables.

+ Directs activities associated with continued regulatory compliance for multiple business functions by monitoring, interpreting, and designing strategy around regulatory changes; determining the impact of changes to the business; providing direction on implementation of changes throughout the business; and providing regulatory input before and during inspections to minimize the risks of future non-compliance.

+ Directs and oversees the implementation of compliance efforts by approving compliance requirements; ensuring the assessment of current state compliance to identify gaps and corrective actions; overseeing the analysis and development of complex compliance standards, policies and procedures, and training; and ensuring the monitoring of ongoing compliance adherence.
****** This is a 100% remote position, and you may be based in any of the following Kaiser Permanente locations: CA, GA, CO, OR, WA, VA, MD, or Washington, D.C.

Minimum Qualifications:


+ Minimum eight (8) years medical coding experience.

+ Minimum four (4) years experience in a leadership role with or without direct reports.

+ Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum ten (10) years experience in health care compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field.

Additional equivalent work experience in a directly related field may be substituted for the degree requirement.


+ Certified Professional Coder from American Academy of Professional Coders OR Certified Coding Specialist from American Health Information Management Association

Additional Requirements:


COMPANY: KAISER

TITLE: Director, Compliance, Medical Coding

LOCATION: Oakland, California

REQNUMBER: 1379059


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.

Required Skill Profession

Other General