Executive Director Revenue Cycle Integrity

Kaiser Permanente   •  

Oakland, CA

Industry: Patient Care


11 - 15 years

Posted 396 days ago

Description: This position is a key executive in the Revenue Cycle organization, connecting clinical care delivery to Revenue Cycle business operations for the Northern California (NCAL) region. This position will work collaboratively with the Vice President, Revenue Cycle-NCAL,and other key clinical and business leaders to develop and drive a multi-year strategic plan designed to develop and sustain world-class clinical documentation practices and coding capabilities.

The position will work in partnership with the medical group to deliver training that addresses identified coding and documentation gaps; and drive consistent regional policies, procedures, workflows, systems and process improvements in hospital and professional service coding, clinical documentation, and coding edits across the Northern CA region.

This executive serves as primary liaison to the Legal, Compliance, Licensing and Accreditation organizations, ensuring that all Revenue Cycle policies and practices align with laws and regulations governing revenue cycle operations. This position works in close partnership with Revenue Cycle leadership to develop and execute a change strategy that aligns regional leadership and key stakeholders to the strategic plan, monitors progress, ensures achievement of key milestones, and mitigates risks and any adverse impact of changes to individual departments, facilities and service areas.

Essential Responsibilities:

  • Strategic Planning: Work collaboratively with the Vice President, Revenue Cycle, and other key clinical and business leaders to develop and drive a multi-year strategic plan designed to develop and sustain world-class clinical documentation and coding capabilities across all care delivery areas within the region.
  • Identify innovative approaches and new business models that maximize the return on KP-s investments in technology (e.g. KP HealthConnect) and its labor-management partnerships to deliver cost-effective and creative business solutions that support achievement of the organization-s strategic objectives.
  • Forecast future technical and informational system needs for all areas of responsibility, and work collaboratively with Revenue Cycle, business and clinical leadership (including the medical group) to identify and implement technological solutions that increase efficiency and ensure that applicable clinical and business systems meet the organization-s future requirements.
  • Monitor trends and changes in legislation and accreditation standards that affect Kaiser Permanente. Advise senior leadership on responses to changes affecting areas of responsibility with region and serve as an internal consultant on Revenue Cycle operations.
  • Develop, in partnership with the medical group, a comprehensive training program to ensure compliance with applicable regulations and contracts within the Revenue Cycle Integrity area.
  • Maintain a working knowledge of relevant third-party payor contracts, accreditation standards, and regulatory trends and practices that may affect the Revenue Cycle organization. Develop strategies to mitigate adverse impact and take advantage of opportunities wrought by relevant trends and changes. Work collaboratively with executive leadership, local leadership and medical group leadership to integrate applicable changes into operations.
  • Management and Operational Leadership: Oversee overall performance and day-to-day operations of the Hospital Coding and Professional Coding Support Services units (performing coding and coding edits) and the Clinical Documentation Integrity department.
  • Identify technical solutions and opportunities to automate manual coding / extraction processes, reduce rework and implement processes to achieve the most cost-effective outcomes possible.
  • Build comprehensive consolidated regional hospital and professional fee coding support services, and clinical documentation integrity programs. Forecast resource requirements and develop a recruitment and retention strategy and job family (including, but not limited to, competency requirements and levels) designed to attract the best talent available to meet the organization-s needs.
  • Develop and implement policies and procedures, productivity standards, processes and training programs designed to produce exceptional quality and performance.
  • Collaborate with the medical group to identify opportunities to enhance clinical documentation completeness.
  • In partnership with the medical group, develop a comprehensive training program to ensure that all policies and practices support documentation and coding practices that remain fully compliant with current laws and regulations.
  • Fiscal Accountability: Collaborate with regional leadership to develop revenue-and-expense projections for the annual budget, establish annual performance targets in keeping with program-wide targets, and assist with quarterly forecasting for the region and its medical centers.
  • Manage Revenue Cycle operating expenses within budget, and seek opportunities to improve efficiency and reduce costs.

  • Performance Excellence: Identify industry-leading best practices and work collaboratively with medical group, medical center and KFHP/H leadership to set industry-leading performance standards for hospital and professional services coding and clinical documentation, ensuring that the region meets or exceeds annual targets.
  • Develop standardized processes and uniform policies and procedures for all areas of responsibility; develop and execute strategies that drive exceptional service delivery to patients and key stakeholders; hold responsible parties accountable for performance.
  • Actively monitor and report on coding and clinical documentation performance, identifying the root causes of issues; take advantage of best practices among facilities; work collaboratively with key stakeholders at the local and regional levels to mitigate risk; develop and execute strategies to improve overall revenue cycle performance.
  • Create a culture of performance excellence in all areas of Revenue Cycle operations, ensuring that clinical services are appropriately documented and coded.
  • Change Leadership: Develop and execute a change leadership strategy that aligns key stakeholders (including, but not limited to, labor, medical group, and functional area leadership) to the strategic plan, and develop strategies and tactics to mitigate risk and any adverse impact of changes to individual departments, facilities and service areas.
  • Develop and execute an integrated communication plan to effectively engage and inform key stakeholders of relevant changes and updates to key business strategies and operating areas.
  • Lead and report into cross-functional revenue optimization work groups composed of senior leaders from the medical group and KFH/HP; provide subject matter and technical expertise to clinical and business areas.
  • Establish a plan to develop leadership capabilities and employee engagement at all levels of the Revenue Cycle Integrity organization; create a culture that achieves high performance and professional integrity.
  • Compliance: Develop and implement action plans for compliance risk within Revenue Cycle operations within scope of accountability.
  • Develop, execute and monitor policies and procedures that enhance clinical documentation integrity and ensure compliance with applicable state and federal regulations; work collaboratively with Compliance leadership to conduct periodic audits of effectiveness in areas of responsibility.
  • Ensure maintenance of the highest level regulatory and contractual compliance within all areas of the Revenue Cycle Integrity organization. Develop and oversee implementation and monitoring of systems that protect the privacy and security of the patient at all times.

Basic Qualifications:

  • Minimum ten (10) years of progressive management and leadership experience in broad progressive Revenue Cycle (charge capture, CDM, and/or professional fee support services preferred), including academic, large group practice or multi-facility health systems experience.

  • Bachelor-s degree in Business Administration with emphasis in Finance, Accounting or related field, or equivalent experience, required.
    License, Certification, Registration
  • N/A

    Additional Requirements:
  • Electronic health information system implementation experience required.

  • A broad knowledge of the health care industry, insurance, managed care and integrated delivery systems.

    Preferred Qualifications:
  • Epic experience preferred.
  • Experience in a unionized environment preferred.

Job Number: 627695