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Senior Director of Compliance for Risk Adjustment
2 months ago
Position Overview:
The Director of Compliance in Risk Adjustment is responsible for overseeing and enhancing a robust compliance framework that adheres to best practices in risk adjustment. This role is pivotal in ensuring adherence to federal, state, and local regulations while fostering ethical conduct within the organization. The Director will guide the risk adjustment compliance initiatives across various programs, including Medicare Advantage, ACA, and Medicaid.
Key Responsibilities:
• Provide strategic leadership in the development and execution of a comprehensive risk adjustment compliance program.
• Act as a subject matter expert in risk adjustment compliance, focusing on coding accuracy and regulatory adherence.
• Oversee internal and external audits related to risk adjustment, ensuring compliance with national policies and procedures.
• Collaborate with cross-functional teams to ensure alignment of compliance activities with organizational objectives.
• Develop and implement annual compliance work plans that reflect business goals and regulatory requirements.
• Monitor and assess compliance risks, providing insights and recommendations to senior management.
• Direct compliance training and development initiatives to enhance workforce capabilities in risk adjustment practices.
• Review and analyze audit results, directing compliance reviews and focused projects based on findings.
• Maintain current knowledge of industry trends and regulatory changes impacting risk adjustment compliance.
• Ensure that compliance documentation is thorough and accessible, facilitating transparency and accountability.
Qualifications:
- Minimum of four (4) years in a leadership capacity within a compliance-focused environment.
- Bachelor's degree in healthcare administration, law, public health, or a related field, along with ten (10) years of relevant experience.
• Advanced degree or equivalent experience in healthcare compliance is preferred.
• Extensive experience with Medicare Risk Adjustment and a deep understanding of related regulations is highly desirable.
• Proven track record of leading compliance teams and managing complex compliance programs.
• Strong analytical skills with the ability to interpret regulatory requirements and implement effective compliance strategies.
• Excellent communication and interpersonal skills, capable of engaging with diverse stakeholders across the organization.
• Knowledge of coding standards and the CMS submission process is advantageous.
• Experience with Risk Adjustment Data Validation Audits is a plus.
In this role, the Director will play a crucial part in ensuring that Kaiser Permanente maintains the highest standards of compliance and ethical conduct in its risk adjustment activities.
