• Senior Manager Risk Adjustment

    Kaiser PermanenteRenton, WA 98057

    Job #1225218693

  • Directs and influences the complex risk adjustment processes, related projects or programs with regional and national resources. Coordinates efforts with national and regional PMG's, Revenue Cycle, Coding, and Medicare Finance leaders, with the goal of capturing complete and accurate risk adjustment data to support Federal and State government reimbursement. Manages coding operations services/systems related to these programs and develops and presents recommendations for improving the effectiveness and efficiency of various processes. Manages the development and execution of project plans.Essential Responsibilities:Coordinates various risk adjustment related processes including but not limited to: Clinical documentation improvement, diagnosis refresh, data mining and algorithms, provider queries, coding abstraction and, Epic system workflows. Coordinates efforts with inter-regional counterparts including RRG, National Medicare Finance, and National CMT. Conducts studies of operational systems including analysis of practices and processes, workflows, and procedures. Monitors and reports on key revenue cycle performance indicators, identifies trends and facilitates improvemen processes. Oversees complete and accurate federal and state risk adjustment reimbursement through coordination and oversight of multi-disciplinary departments and processes. Partners with PMG partners and Coding to provide targeted and broad based risk adjustment education. Participates in national and regulatory audits and related projects (i.e., Benchmark, Probe audits).Basic Qualifications:ExperienceMinimum four (4) years of management experience. Minimum six (6) years of health care experience, to include management of large scope, complex projects/processes. EducationBachelor's degree in business, health care management or clinical related field. License, Certification, RegistrationN/A Additional Requirements:N/A Preferred Qualifications:Experience with Coding or CMS HCC reimbursement models is preferred. Master's degree in business, health care management or clinical related field. Extensive knowledge of health care issues and the health care industry. Exceptional communication, influencing and partnering skills at all organizational levels.Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.COMPANY: KAISERTITLE: Senior Manager Risk AdjustmentLOCATION: Renton, WashingtonREQNUMBER: 885679External 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.