Medicaid Compliance Data and Reporting Consultant IV

Kaiser Permanente; Oakland (CA); On-site; USD 120,000 - 150,000; Full time

Job summary

Kaiser Permanente is seeking a high-impact consultant IV to support Data and Reporting within Medicaid Health Plan Compliance. You will coordinate external regulatory audits, gather documents, prepare presentations, and track quality reviews and submissions across the NW market.

You will also help with infrastructure strategy and development for audit management tools and processes. The role emphasizes collaboration with internal and external stakeholders, developing compliance reports, and

Qualifications

• Bachelor's degree in a related field required.
• Minimum six (6) years experience in compliance, health care operations, audit, finance, regulatory or related field.

Responsibilities

• Coordinate and audit manage external regulatory audits.
• Support NW market audits and collaborate across departments for document collection, meetings, quality reviews and submissions.
• Assist with development of compliance plans and monitoring of regulatory changes.

Skills

Ambiguity management

Attention to detail

Business knowledge

Communication

Critical thinking

Cross-group collaboration

Decision making

Dependability

Influencing others

Problem solving

Teamwork

Topic-specific communication

Education

Bachelor's degree

Job description

This consultant IV role supports functions for the Data and Reporting team within Medicaid Health Plan Compliance. Responsibilities focus on coordination and audit management of external regulatory audits. This position will primarily support the NW market audits, collaborating with various departments for document collection, meeting presentations, quality reviews, audit submissions, data entry, reporting, etc. The role may also support infrastructure strategy and development such as tools, processes, and various resources that support the audit management function.

Job Summary

This individual contributor is primarily responsible for conducting company compliance activities in collaboration with internal and external stakeholders. Responsibilities include developing compliance reports, conducting compliance investigations, coordinating implementation of compliance efforts, and assisting with regulatory compliance through monitoring regulatory changes. This individual contributor also assists with and supports management of projects including assisting in development and coordination of plans and coordinating with stakeholders.

Essential Responsibilities

• Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers; building relationships with cross-functional stakeholders; influencing others through technical explanations and examples; adapting to competing demands and new responsibilities; listening and responding to, seeking, and addressing performance feedback; providing feedback to others; creating and executing plans to capitalize on strengths and develop weaknesses; supporting team collaboration; and adapting to and learning from change, difficulties, and feedback.
• Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities.
• Conducts company compliance activities by collaborating with internal and external stakeholders; applying established regulations and standards to compliance efforts; providing insight and recommendations for the design, development, and execution of strategic compliance initiatives; and documenting compliance activities.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations); and developing draft presentations to convey key findings.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential action steps; and providing input for the creation of corrective action plans for substantiated allegations.
• Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts.
• Assists with ensuring regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts; and supporting the implementation of designated changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the current state of compliance to identify gaps and corrective actions; creating or revising moderately complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

Knowledge, Skills and Abilities: (Core)

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

• Analytical Skills
• Compliance Management
• Cross Department Coordination
• Getting Work Done Through Others
• Negotiation
• Project Management
• Technical Communication
• Written Communication

Minimum Qualifications

• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum six (6) years experience in 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.

Preferred Qualifications

• Four (4) years medical coding experience.
• Four (4) years experience in privacy and security compliance.