Remote Risk Adjustment Compliance and Coding Leader

Kaiser Permanente; Pasadena (CA); On-site; USD 139,000 - 180,000; Full time

Job summary

Kaiser Permanente in Pasadena, CA, seeks a Senior Compliance Manager specializing in coding and risk adjustment. You will oversee coding audits, develop annual audit plans, ensure adherence to coding policies, and lead cross-functional regulatory initiatives across the organization.

Responsibilities include managing compliance programs, presenting findings to leadership, and guiding teams to improve coding quality while aligning with KP's standards and governance framework.

Qualifications

• Minimum five (5) years medical coding experience.
• Minimum two (2) years experience in a leadership role.
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum six (6) 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 Risk Adjustment Coder from American Academy of Professional Coders OR Certified Coding Specialist from American Health Information Management Association OR Certified Professional Coder from American Academy of Professional Coders

Responsibilities

• Pursues professional growth and provides developmental opportunities for others by soliciting and acting on performance feedback; building collaborative, cross-functional relationships; training and developing talent for growth opportunities; delegating tasks and decisions; fostering open dialogue amongst team members; executing performance management guidelines and expectations; and working closely with employees to set goals and provide open feedback and coaching to drive performance improvement.
• Manages designated work unit by translating business plans into tactical action items; ensuring all policies and procedures are followed; delegating tasks to meet goals and objectives; overseeing the completion of work assignments; aligning team efforts; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; removing obstacles that impact performance; and guiding performance and developing contingency plans accordingly.
• Manages company compliance activities by partnering with internal and external stakeholders; applying established regulations and standards to compliance efforts; managing the design, development, and execution of strategic compliance initiatives; overseeing the analysis of regulations and regulatory changes, and their application to operations; and overseeing the documentation of compliance activities.
• Manages compliance reporting efforts across one or more business functions by managing 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 leadership and external business stakeholders.
• Manages compliance investigations across one or more business functions by managing the collection and analysis of quantitative and qualitative data; leading interviews as appropriate; researching key business issues; and evaluating and recommending corrective action plans for substantiated allegations.
• Manages projects or compliance components of larger cross-functional projects by identifying and managing stakeholder contacts; assembling teams based on project needs and team member strengths; developing, analyzing, and managing project plans; negotiating and managing project schedules and resource forecasts; and managing project financials and deliverables.
• Manages activities associated with continued regulatory compliance for one or more 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 organization; and providing regulatory input before and during inspections to minimize the risks of future non-compliance.
• Manages the implementation of compliance efforts by approving compliance requirements; ensuring the assessment of current state compliance to identify gaps and corrective actions; managing the analysis and development of complex compliance standards, policies and procedures, and training; and ensuring and monitoring ongoing compliance adherence.

Skills

Medical coding

Leadership

Regulatory compliance

Auditing

Data analysis

Education

Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field

Certified Risk Adjustment Coder (AAPC) OR Certified Coding Specialist (AHIMA) OR Certified Professional Coder (AAPC)

Job description

Kaiser Permanente in Pasadena, CA, seeks a Senior Compliance Manager specializing in coding and risk adjustment. You will oversee coding audits, develop annual audit plans, ensure adherence to coding policies, and lead cross-functional regulatory initiatives across the organization.

Responsibilities include managing compliance programs, presenting findings to leadership, and guiding teams to improve coding quality while aligning with KP's standards and governance framework.