Recognized content expert in the following areas: Scope of practice, release of information and auditing. Responsible for leading the auditing team and other projects in addition to conducting audits. Lead assessments at medical centers as needed and provide consultation on compliance and regulatory requirements. Responsible for providing relevant content expertise to directors, chiefs and staff. Builds and maintain key relationships with TPMG managers, physicians, leaders and departmental staff as appropriate. Acts as thought partner and provides leadership to project managers and provides expert advice on specific area of expertise.
Working under the direction of the Compliance & Privacy Officer adheres w/ KP Compliance Framework, fosters comprehensive compliance projects through a series of activities to comply w/ all applicable regulations & statutes. Provides professional/technical guidance to team member & employees at large & presents complex information throughout the organization. Impacts the achievement of key functional &/or KP objectives that have direct & significant business impact. Contributes to the development of the department's objectives & annual risk assessments, work & audit plans. Could have a primary functional area of emphasis in one or more of these areas: Investigations, Scope of Practice, Privacy, Health Information Mgmt/Coding, Revenue Cycle, External or Internal Auditing or Statistical Analysis.
Essential Functions:
- Project Planning: Oversees &/or directs teams in identifying accountabilities for local/regional compliance programs & consulting staff
- Oversees the development & completion of annual risk assessments
- Establishes compliance goals, timelines, approaches & strategies in support of organizational initiatives
- Identifies areas of performance improvement & establishes/delegates resources to lead compliance-related projects
- Oversees & leads on-going efforts to establish, identify & manage internal/external resources & agency relationships
- Investigations: Oversees the administration of investigation processes & activities
- Establishes & promotes a collaborative environment w/ other functional areas in investigating potential compliance issues
- As needed for sensitive or political situations, will participate & assist w/ investigation interviews, findings & recommendations
- Collaborates w/ clients to determine complex corrective action plans
- Validation: Manages & leads audits on scope of practice, licensing, site of service & other identified areas at risk for compliance violations
- Oversees the administration of compliance programs & content, including design, completion of risk assessments &/or audits, investigations processes & activities, instances of reported non-compliance
- Assesses completion rates & operational sustainability
- Determines impacts of implementation of new regulations & statutes & required notifications, changes, & training
- May engage external regulatory & legislative bodies on developing regulations & laws
- Implementation: Identifies & implements OIG compliance requirements
- Performs on-going assessment of established solutions to existing alternatives & makes recommendations as needed to implement changes
- Leads & participates in the creation, revisions & development of compliance standards, policies & procedures
- Leads the monitoring of compliance adherence
- Directs reporting on compliance efforts & programs to all levels of the organization
- Influences mgmt & staff to ensure compliance & reporting
- Oversees the development &/or delivery of compliance & ethics training
- Program Mgmt: Facilitates communications, manages relationships w/ stakeholders, & negotiates agreement from involved parties for compliance initiatives & programs across service areas
- Responsible for issue mgmt, response, & mitigation across service areas
- Anticipates issues through regular communication w/ reporting positions & other internal & external parties, mitigating risk or escalating issues for resolution by more senior levels as necessary
- Responsible for leading change mgmt efforts in service areas as well as larger dept'l goals or objectives
- Identifies & acts upon opportunities to leverage and engage direct reporting team in change mgmt activities
- Perform other duties as assigned
Secondary Functions:
Works closely with TPMG Departments to ensure that operational workflows are compliant and meet regulatory requirements. Effectively leads project teams on work related to specific area of expertise. Provides leadership for the design, development, and implementation of projects related to their area of expertise. Manages the work of all project participants, including outside consultants and other department staff, when used. Serves as a content expert for responsible area of expertise.
Provides assistance and advice to others in support of project work. May provide expert consultation to multiple projects at any given time. Effectively interfaces with TPMG and KFH clients to reach mutually acceptable agreements around project scope, objectives, deliverables, timeframes and outcomes. Effectively facilitates interactions with clients and stakeholders to achieve desired outcomes. Provides leadership and direction in accordance with the overall strategic direction of the TPMG Departments and organization. Develops clear project plan that allows teams to achieve desired outcomes. Monitors plan on an ongoing basis and proactively adjusts, as necessary, to resolve barriers and/or issues. Oversees work to ensure high quality deliverables and adherence to timeframes and budget (when applicable). Proactively identifies links between specialty work and broader organizational priorities and goals. Identifies areas where specialty expertise may enhance work of department.
Contributes to a team environment that encourages collaboration, supports receiving and providing feedback and encourages participation from all levels of staff. Adapts management style as appropriate to meet needs of a particular situation or team resulting in optimal performance. Actively provides feedback to staff in support of individual staff development.
Communicates in a manner that is proactive, timely, influential, persuasive and effective resulting in mutually acceptable agreements. Ensures that all communications produced under his/her direction are timely and of high quality. Participates in the development and management of department staff through coaching, providing and encouraging feedback, consistent application of department policies and procedures, conducting project based performance reviews, and other departmental activities. Participates in development of staff through the sharing of new techniques and problem solving approaches specific to their area of expertise. Participates in the development and implementation of department-wide activities that support the culture and values of the department.
Consisently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures.
Qualifications:
Basic Qualifications:
- Eight (8) - Twelve (12) years of progressive experience in a Health Care Environment, (managerial or clinical disciplines) with at least five years in healthcare compliance and privacy
- Focused experience in any of the following areas: Revenue Cycle, Clinical Documentation/Coding, Risk Management, Auditing/Claims Review, Project Management, Defense Auditing preferred
- Master's degree or equivalent experience in Health Care Administration, Business Administration, Finance, Economics, Operations Research, Public Health or other Health Care related field
- Certified in Healthcare Compliance (CHC) or other equivalent compliance certification preferred
- If applicant does not have the CHC, then must complete within 12 calendar months of hire
- Advanced knowledge of compliance principles, theories, and concepts
- Extensive knowledge of health care compliance policies, programs, practices, systems, related compliance issues
- Thorough knowledge of the elements of an effective Ethics and Compliance program and broad knowledge of health care industry practices and standards including both federal, state regulations and accreditation standards
- Excellent Skills in written and verbal communication, meeting facilitation, presentations, analysis, collaboration, project management, decision making, stewardship, negotiation, and leadership
- Strong knowledge of federal and state reimbursement program requirements (e.g. Medicare and Medi-Cal) and privacy and consent laws
Preferred Qualifications:
- Knowledge of TPMG operations and/or business of Kaiser Permanente preferred.
- Typically at least 5 or more years experience in their field of expertise preferred. This may include but is not limited knowledge of care health care delivery, technical/analytic expertise such as KP Health Connect, management, operations and planning.
- Kaiser Permanente knowledge preferred.
- Clinical background preferred but not required.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.