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Director, Compliance, Medical Coding
About the position
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).
Responsibilities
- Demonstrates continuous learning and maintains a highly skilled and engaged workforce by aligning resource plans with business objectives.
- Oversees the recruitment, selection, and development of talent; motivating teams; preparing individuals for growth opportunities and advancement.
- Stays current with industry trends, benchmarks, and best practices; provides guidance when difficult decisions need to be made.
- Ensures performance management guidelines and expectations drive business needs.
- Oversees the operation of multiple units and/or departments by identifying customer and operational needs.
- Analyzes resources, costs, and forecasts and incorporates them into business plans.
- Gains cross-functional support for business plans and priorities; translates business strategy into actionable business requirements.
- Obtains and distributes resources; sets standards and measures progress; removes obstacles that impact performance.
- Guides performance and develops contingency plans accordingly; ensures products and/or services meet customer requirements and expectations.
- Oversees company compliance activities by ensuring team members provide support to internal and external stakeholders.
- Reviews and approves compliance activities; designs strategies for the implementation of regulations and regulatory changes.
- Ensures compliance activities are fully documented; oversees the resolution of compliance issues.
- Directs compliance reporting efforts across multiple business functions by overseeing the evaluation and summary of compliance data.
- Identifies and reports key compliance drivers, liabilities, and performance indicators to senior management.
- Develops 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.
- Conducts interviews on escalated issues as appropriate; reviews and evaluates research on key business issues.
- Evaluates and recommends corrective action plans for substantiated allegations.
- Directs programs or compliance components of larger cross-functional programs by identifying and managing stakeholder contacts.
- Assembles teams based on program needs and team member strengths; develops, analyzes, and manages program plans.
- Negotiates and manages program schedules and resource forecasts; manages program financials and deliverables.
- Directs activities associated with continued regulatory compliance for multiple business functions by monitoring, interpreting, and designing strategy around regulatory changes.
- Determines the impact of changes to the business; provides direction on implementation of changes throughout the business.
- Provides 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.
- Ensures the assessment of current state compliance to identify gaps and corrective actions.
- Oversees the analysis and development of complex compliance standards, policies and procedures, and training.
- Ensures the monitoring of ongoing compliance adherence.
Requirements
- Minimum eight (8) years medical coding experience.
- Minimum four (4) years experience in a leadership role with or without direct reports.
- Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.
- Minimum ten (10) years experience in health care compliance, health care operations, audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field.
- Certified Professional Coder from American Academy of Professional Coders OR Certified Coding Specialist from American Health Information Management Association.
Benefits
- 100% remote position, with the option to be based in CA, GA, CO, OR, WA, VA, MD, or Washington, D.C.
