Senior Manager, Risk Adjustment Perspective Coding Management (Medicare)

Kaiser Permanente-posted 4 months ago

Senior

Baltimore, MD

Ambulatory Health Care Services

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The Senior Manager role, reporting to the Senior Director in Risk Adjustment, will manage 3-4 direct reports in the Medicare risk adjustment coding of medical records utilizing Epic EMR with application of RA standards. This role will support development and maintenance of key risk adjustment policies and procedures (coding guidance, chart review, deletes, QA). Responsibilities include PowerPoint presentation and execution of various regulatory audits (RADV, HHS, OIG). The position guides risk management programs by driving teams to proactively plan for and conduct complex audits and analyses to evaluate risk management programs. It facilitates and holds teams accountable for planning and organizing reporting and specialized data analysis for professional liability cases, risk management trends and issues, significant events, and near misses. The role collaborates across organizations to manage collection and analysis of data from multiple reporting systems, sources, and emerging industry trends to identify opportunities to improve risk and threat management.

Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships.
Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement.
Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning.
Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends.
Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams.
Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope.
Manages designated units or teams by translating business plans into tactical action items.
Aligns team efforts; builds accountability for and measuring progress in achieving results.
Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans.
Removes obstacles that impact performance; identifies and addresses improvement opportunities.
Ensures compliance by identifying and recommending improvements for long-term policies and procedures.
Manages Risk Management consulting by holding teams accountable for providing proactive expert strategic advice.
Guides documentation, analysis, and reporting by providing expert support and guidance to team.
Oversees Risk Management education and training by managing development and implementation of a comprehensive training program.
Manages Risk Management incidents by providing expert guidance in response to highly complex incidents.
Guides Risk Management programs by driving implementation, planning, and development of comprehensive risk reduction programs.
Manages threat monitoring and risk prevention by collaborating across organizations to manage data collection and analysis.

Minimum one (1) year of experience managing operational or project budgets.
Minimum four (4) years of experience in a leadership role with direct reports.
Minimum five (5) years of experience using medical terminology.
Minimum three (3) years of program / project management experience.
Bachelor's degree in Analysis, Research, Statistics, Health Care (e.g., Registered Nurse), Healthcare Administration, Health Care Management, Economics, Business, Homeland Security, or related field AND minimum six (6) years of experience in risk management, quality program, claims management, patient safety, or directly related field OR Minimum nine (9) years of experience in risk management, quality program, claims management, patient safety, or a directly related field.

Knowledge of confidentiality and business relationship management.
Skills in conflict resolution, relationship building, and risk assessment.
Ability to adapt, organize, and identify legal risks.
Experience with health information systems and systems thinking.
Proficiency in change management, negotiation, and business process improvement.
Understanding of loss prevention, compliance management, and health care compliance.
Familiarity with internal controls, applied data analysis, and member service.
Knowledge of patient safety and Microsoft Office.

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Senior Manager, Risk Adjustment Perspective Coding Management (Medicare)

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