Kaiser Permanente Director of Documentation Quality & Training in Oakland, California
The incumbent is responsible for providing strategic leadership and direction in achieving the TPMG's Documentation, Coding and Benefit Implementation goals. This includes working collaboratively with other TPMG and KFHP/H departments to develop, coordinate, monitor and stream line operations focused on the appropriate and accurate capture of patient diagnoses by physicians and other clinicians. In addition, the incumbent has accountability for ensuring that services provided to members are properly adjudicated against member benefits and taking into consideration full charge capture and total claims adjudication. The director oversees a team of resources who have primary accountability for a functional area which may include: auditing, data mining, claims, revenue cycle, charge capture, clinician&staff training, benefits assessment and implementation, and systems&applications support.
Essential Functions: - Serves as a Documentation and Coding expert, advising TMPG Executive and Medical Center Leadership on all Risk Adjustment Plans, Revenue Cycle issues, Benefit Assessment and Implementation and other complex healthcare issues of strategic importance. - Provides leadership and direction in accordance with the overall strategic operational goals of TPMG. - Applies thorough understanding of key business processes to effectively anticipate and address long-term implications of decisions and actions. - Participates in collaborative goal setting and strategic planning with key stakeholders. - Partners with other departments and teams to support and champion regional initiatives. Examples include: Quality, Compliance, Revenue Cycle, Finance, Benefits Administration, KP Health Connect, Training and Education and Medical Center Operations. - Fosters a positive and pro-active work environment, emphasizing respect for individuals, high standards of quality, customer service, innovation and team work. - Effectively communicates leadership messages, models leadership behaviors and supports change management. - Directs a team of managers fostering a strong results orientation by motivating staff and holding them accountable to meeting service, quality and operational goals.
Qualifications: Basic Qualifications: Experience - Minimum seven (7) years of experience with increasingly challenging projects. - Minimum five (5) years of management experience. Education - Bachelor's degree in business administration, economics, finance, accounting or related field required. License, Certification, Registration - N/A
Additional Requirements: - Ability to interpret and apply Federal and State regulations, coding and billing requirements. - Required knowledge of compliance and regulatory requirements for all reimbursement models for inpatient and outpatient documentation and coding. - Demonstrated ability to understand analytical data and audit findings to identify coding trends and other risk areas. - Demonstrated ability to interpret audit findings to physician partners and develop appropriate training plans and materials based on audit results. - Knowledge of coding practices in both the office and inpatient settings. - Knowledge of benefit plans, billing and claims adjudication processes and fee schedules. - Knowledge of KFHP insurance products and plans, including benefits. - Demonstrated ability to manage a large and diverse resource team. - Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications: - Five (5) years ofworking within health care industry. - Five (5) years of working with electronic health record systems and web based applications. - Seven (7) years of experience with clinical medical record auditing or other Revenue Cycle experience. - Master's degree preferred. - Current coding certification preferred. - Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data. - Demonstrated ability to constructively and sensitively provide feedback to providers and medical centers. - Demonstrated ability to develop data requirements and work with analytical groups to extract, organize and analyze coded data.
COMPANY Kaiser PermanenteTITLE Director of Documentation Quality & TrainingLOCATION Oakland, CAREQNUMBER 638302
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.