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Kaiser Permanente Executive Director, Revenue Management Compliance in Oakland, California

Job Summary:

Reporting directly to the VP, Care Delivery and Revenue Management Compliance (CD&RMC), this position serves as the compliance leader for the Ethics and Compliance – Revenue Management Compliance Program for Kaiser Foundation Hospitals and Health Plan. This program includes but is not limited to oversight, education, training, auditing and monitoring for consistency Program-wide, and assessment of compliance risks associated with Kaiser Permanentes revenue management compliance programs, with an increased focus on risk adjustment. This position partners with national and regional business leaders to coordinate the successful execution of relevant strategic compliance initiatives, metrics and compliance controls. In short, this position:

  • Facilitates effective decision making on applicable business decisions with compliance implications at the executive level.

  • Implements a system of compliance management information to inform risk mitigation decisions related to revenue management compliance to be used Program-wide.

  • Be responsible for both leadership and subject matter expertise on revenue management compliance requirements.

  • Has responsibility for the development, monitoring, and delivery of the ethics and compliance program’s work plan as it pertains to revenue management compliance. The position may interface regularly with regional compliance officers (RCOs) and national leaders to evaluate progress and suggest changes when necessary.

Essential Responsibilities:

  • Advises VP of areas of high risk/vulnerability and directs or participates in the mitigation strategies to address risks.

  • Responsible for partnering with revenue management functional areas, regional and local operational department business leaders to implement the Revenue Management Compliance program.

  • Responsible for regulatory activity infrastructure including regulatory reporting submissions, tracking new laws and regulations, assessing operational impacts, key compliance controls and systems, policies, and performance metrics.

  • Proactively identifies and resolves potential issues and problems, monitors operations performance against laws, regulations, performance guarantees, audit trends and areas of risk.

  • Partners with revenue management functional areas in an effort to ensure ongoing operational monitoring covers regulatory requirements and proactive audit readiness activities are aligned with prioritized risk areas.

  • Directs the development of executive reporting/dashboards and robust internal tracking systems to easily manage and respond to compliance trends.

  • Establishes methods to proactively identify and monitor risk and drive compliance to reduce regulatory risk exposure.

  • Promotes leadership visibility into compliance performance, monitoring/auditing results, training/education, and facilitates escalation of risks/issues to accountable leaders as appropriate.

  • Responsible for investigations related to revenue management compliance matters.

  • Accountable for regional Revenue Management compliance support and developing and implementing a collaborative strategy to standardize, drive consistency across regions, including clear role accountability, auditing, monitoring and corrective action functions.

  • Directs the development and maintenance of Revenue Management Compliance operational policies and procedures, as well as internal tools and reference documents.

  • Oversees compliance monitoring and directs allocation of compliance resources to support business/regional initiatives, as appropriate.

  • Leads compliance risk assessment for Revenue Management Compliance and coordinates with business partners on mitigation activities.

  • Monitors completion/implementation of remediation plans and controls that supports strategic business initiatives. Escalate to leadership any barriers with successful completion/implementation.

  • Leads compliance efforts to collaborate and coordinate with revenue management functional areas, compliance leaders, the Federation, and Internal Audit Services to coordinate an effective approach to regulatory activities, risk assessment, auditing and monitoring.

  • Develops a team of professionals and subject matter experts by providing support for professional growth, and by offering timely feedback, coaching, and performance reviews. Establish processes to support appropriate and sustainable care delivery and quality compliance coverage. Plans for succession and executes as needed.

  • Responsible for recruitment, hiring, promoting and transferring/reassigning of staff; role modelling an appreciation for diversity, equity, and inclusion.

    Basic Qualifications:

    Experience

  • 10+ years of escalating managerial work-experience in a highly diversified organization.

  • 10+ years of escalating responsibility and work-experience in compliance field (internal audit, law, etc.); to include progressive management roles in large, complex organizations with successive levels of accountability and results.

    Education

  • Bachelors degree in degree in related field (Health Care, Business, etc.).

    License, Certification, Registration

  • N/A

    Additional Requirements:

  • Skilled people manager

  • Skilled at cross cultural communications and management

  • Extensive experience working with cross-functional teams, business users and vendors

  • Demonstrated ability to build strong internal and external relationships that ensure the successful delivery of compliance policy

  • Operational experience and understanding of the financial process and principles

  • Excellent presentation, verbal and written communication, interpersonal, analytical, decision-making, problem solving, project management, negotiation, and customer service skills

  • Strategic business management and organizational planning skills

  • Strong leadership, management and negotiation skills

  • Ability to build relationships, and foster a cooperative work environment with a wide range of constituencies in a diverse community

  • Ability to build consensus and to work through others in achieving desired results and objectives

  • Consistent ability to set and deliver against a plan in a fast-paced environment with constant attention to detail 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 compliance department.

  • Demonstrated expertise in organizational development, project management, and strategic planning.

  • Superior communications skills (both oral and written).

  • Demonstrated high ethics and integrity.

  • Strong revenue management compliance experience, including health system revenue cycle and/or health plan risk adjustment

  • Strong verbal and written communication skills and demonstrated proven leadership

  • Strong analytical skills with excellent problem-solving abilities with ability and judgment to ask tough questions

  • Passionate leader capable of driving cross-organizational efforts to evangelize the platform and vision directly tied to compliance

    Preferred Qualifications:

  • Masters degree Nursing or law preferred.

  • Certification in Healthcare Compliance (CHC); coding and/or billing certifications from organizations, such AHIMA or AAPC preferred.

  • COMPANY: KAISER

TITLE: Executive Director, Revenue Management Compliance

LOCATION: Oakland, California

REQNUMBER: 1034551

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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