Head of Risk Adjustment Compliance Strategy

2 weeks ago

Oakland, California, United States Kaiser Permanente Full time

Position Overview:

The Director of Compliance for Risk Adjustment is responsible for the strategic oversight and enhancement of a robust compliance program aimed at ensuring adherence to legal standards and ethical practices within the realm of risk adjustment. This role is pivotal in steering the compliance initiatives across various risk adjustment domains, including Medicare Advantage, Affordable Care Act (ACA), and Medicaid.

Key Responsibilities:

• Provide expert guidance on risk adjustment compliance, ensuring alignment with national policies and procedures.

• Lead internal and external audit activities related to risk adjustment, ensuring thorough monitoring and reporting of compliance metrics.

• Develop and implement an annual compliance work plan that aligns with organizational goals, while reviewing audit findings and directing compliance reviews based on these outcomes.

• Foster a culture of continuous improvement by mentoring and developing a skilled workforce, ensuring that team members are equipped with the necessary tools and knowledge to excel.

• Oversee the operational aspects of compliance activities, ensuring that all processes meet regulatory requirements and organizational standards.

• Direct compliance reporting efforts, summarizing key data and presenting findings to senior management and stakeholders.

• Manage compliance investigations, analyzing data and conducting interviews to address any escalated issues effectively.

• Collaborate with various departments to ensure comprehensive risk adjustment compliance and drive process enhancements.

• Stay informed on industry trends and regulatory changes, advising on their implications for the organization and recommending necessary adjustments to policies and procedures.

Qualifications:

• A minimum of four years in a leadership role, with substantial experience in health care compliance or related fields.

• A bachelor's degree in health care administration, business, or a related discipline, with at least ten years of relevant experience.

• Preferred qualifications include a master's degree and extensive experience in Medicare Risk Adjustment and compliance leadership.

• Strong analytical skills and the ability to communicate complex compliance issues clearly and effectively.

• Proven track record of leading teams and managing cross-functional projects within a compliance framework.

Work Environment:

This position is designed for a remote work setting, allowing for flexibility while ensuring that compliance objectives are met efficiently.

Kaiser Permanente is committed to fostering an inclusive and diverse workplace, emphasizing the importance of equity and belonging in all aspects of our operations.

We are an equal opportunity employer, dedicated to creating a diverse workforce that reflects the communities we serve.

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