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Benefit Coding Consultant ll

1 month ago

Pasadena, United States Kaiser Permanente Full time

The Benefits Administration Coding Team (BACT) is a dynamic team composed of medical coding professionals. BACT closely partners with the benefit policy team to codify policy language into industry standard medical coding methodologies (CPT, HCPCS, ICD-10-CM) to allow for the systematic adjudication of medical claims through our systems. The BACT leads initiatives for California benefit policy and national preventive medicine.

The Benefit Coding Consultant II will work across teams within Kaiser Permanente to support the implementation of benefit changes by providing coding recommendations that leverage their coding expertise, departmental resources, and tools.

Job Summary:

Serves as part of a consultant team under the guidance of more senior team members to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects. Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state. Supports strategic planning and organizational alignment and prioritization of business initiatives. Manages projects or project components under the guidance of team members, participates in change management activities, and performs data analyses in support of business initiatives. Supports compliance of work activities by adhering to relevant policies and procedures.

Essential Responsibilities:

  • Pursues effective relationships with others by sharing resources, information, and knowledge with coworkers and members. Listens to, addresses, and seeks performance feedback. Pursues self-development; acknowledges strengths and weaknesses based on career goals and takes appropriate development action to leverage / improve them. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work. Assesses and responds to the needs of others to support a business outcome.

  • Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines; follows procedures and policies, and applies data and resources to support projects or initiatives with limited guidance and/or sponsorship. Collaborates with others to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities.

  • Serves as part of a consultant team under the guidance of more senior team members to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects within a functional track or workstream by identifying and ensuring representation and inclusion of appropriate stakeholders; building rapport and partnerships with stakeholder teams, third party vendors, and senior management; working with stakeholders to develop goals and set the prioritization of deliverables; identifying and escalating tough stakeholder issues while maintaining an independent perspective; and preparing presentations and reports.

  • Develops requirements for business, process, or system solutions within assigned business domain(s) by working with stakeholders and cross-functional teams as appropriate; leveraging business requirements gathering methodologies to identify business, functional, and non-functional requirements; and assisting in the development and documentation of business cases to assess the costs, benefits, and ROI of proposed solutions.

  • Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state by maintaining a working understanding of how current processes impact business operations; mapping current state against future state processes; identifying the operational impact of requirements on upstream and downstream solution components; and identifying and validating value gaps and opportunities for process enhancements or efficiencies.

  • Supports strategic planning and organizational alignment and prioritization of business initiatives by evaluating performance metrics, standards, and methods to establish business success; working with multiple stakeholders, often with competing/conflicting objectives, to ensure cohesive and reachable metrics; and executing assigned initiatives to ensure delivery of measurable results and alignment with strategic objectives.

  • Serves as a advocate of continuous learning and professional development by building a working knowledge of industry practices, standards, and benchmarks; attending and participating in roadshows, conferences, and speaking events; supporting the ongoing enhancement and innovation of consulting practices, standards, and methods across KP; and serving as an advocate to ensure continuous learning and improvement is championed as a people strategy.

  • Manages projects or project components under the guidance of team members by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; consulting in the development, analysis, and management of project plans; coordinating project schedules and resource forecasts; proactively monitoring and identifying project or business initiative risks, issues, and trigger events; and resolving or escalating risks or issues as appropriate.

  • Participates in change management activities associated with business initiatives by engaging stakeholders to obtain support and buy in for changes; using appropriate change management methods and approachs; and ensuring stakeholders understand initiative intent and purpose.

  • Performs data analyses to support business initiatives by using appropriate data analysis tools and approaches to assess business performance; leveraging suitable data gathering and analysis methods (e.g., process observation, hard data, etc.); and conducting analyses and performing experimental tests to evaluate the effectiveness of business solutions.

  • Supports compliance of work activities by adhering to KP, departmental, and/or business line policies and procedures.

    Minimum Qualifications:

  • Bachelors degree from an accredited college or university OR Minimum three (3) years experience in consulting, project management, data analytics, operations or a directly related field.

    Additional Requirements:

  • Knowledge, Skills, and Abilities (KSAs): Creativity; Applied Data Analysis; Conflict Resolution; Service Focus

COMPANY: KAISER

TITLE: Benefit Coding Consultant ll (Consultant II)

LOCATION: Pasadena, California

REQNUMBER: 1292316

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.