Senior Manager, Risk Adjustment Coding Management (Medicare)

Guides risk management programs by driving teams to proactively plan for and conduct complex audits and analyses to evaluate risk management programs. Facilitates and holds team accountable for planning and organizing reporting and specialized data analysis for professional liability cases, risk management trends and issues, significant events, and near misses. Collaborates across organizations to manage collection and analysis of data from multiple reporting systems, sources, and emerging industry trends to identify opportunities to improve risk and threat management. Manages and provides expert guidance in response to highly complex incidents, and development of response protocols. Holds teams accountable for providing proactive expert strategic advice for clinical and non-clinical staff across organizations regarding all risk management issues (e.g., regulatory requirements, trends, impacts on key internal stakeholders). Partners cross-functionally to ensure team serves as a resource and effectively disseminates information to providers, staff, and external partners across organizations on risk trends and avoidance. Identifies and recommends improvements for long-term policies and procedures to maintain compliance with State and Federal laws, regulations, patient rights, and professional ethics.

• Creates and advocates for developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works with leaders and employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; hires, trains, and develops talent for growth opportunities; strategically evaluates talent for succession planning; sets performance management guidelines and expectations across teams / units. Oversees implementation, adapts, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends; shares best practices within and across teams. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams; motivates teams to meet business objectives. Delegates tasks and decisions as appropriate; provides appropriate support, guidance and scope; encourages development and consideration of options in decision making; fosters access to stakeholders.


• Manages designated units or teams by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed; partners with key stakeholders and business leaders to ensure products and/or services meet requirements and expectations while aligning with departmental strategies. Aligns team efforts; builds accountability for and measuring progress in achieving results; assumes responsibility for decision making; fosters direct reports to resolve escalated issues as appropriate. Communicates goals and objectives; incorporates resources, costs, and forecasts into team and unit plans; ensures matrixed resources are fulfilling service or performance requirements across reporting lines. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams and units to operate in alignment with operational and business objectives.


• Ensures compliance by: identifying and recommending improvements for long-term policies and procedures to maintain compliance with State and Federal laws, regulations, patient rights, and professional ethics; promoting a culture of compliance and ensuring compliance with Kaiser Permanentes policies and procedures and applicable federal and state laws and regulations; strategically guiding interactions with and acting as a senior administrative liaison to assist other departments in complying with highly complex accreditation and regulatory risk management requirements (e.g., policies and procedures, legal claims manager), serving as an expert advisor to drive innovating solutions; holding teams accountable for preparation for and participation in highly complex regulatory audits and related projects (e.g., annual audits, accrediting bodies); and overseeing teams knowledge and application of diverse, highly complex and rapidly changing laws, regulations, codes, policies, and standards as they apply to risk management.


• Manages Risk Management consulting by: holding teams accountable for providing proactive expert strategic advice for clinical and non-clinical staff across organizations regarding all risk management issues (e.g., regulatory requirements, trends, impacts on key internal stakeholders); managing planning and implementation of communications, outreach, and education as part of a comprehensive response plan to mitigate risk; providing expertise as requested by participating in working groups (e.g., committees, forums, task forces) related to risk management activities; and managing comprehensive efforts to monitor new practices to identify and mitigate additional risk and assist departments across organizations in minimizing and avoiding liability.


• Guides documentation, analysis, and reporting by: providing expert support and guidance to team in designing, managing, and maintaining sophisticated risk management data sources; providing general guidance for development and execution of a comprehensive plan for documenting professional liability cases, risk management trends and issues, significant events, and near misses; monitoring the design, development, and production of reports on scheduled cadence to senior leadership, Board committees, and regulators; facilitating and holding team accountable for planning and organizing reporting and specialized data analysis for professional liability cases, risk management trends and issues, significant events, and near misses; managing the creation of data and risk analyses to identify trends and facilitate improvements; driving the utilization of reports and analyses to develop recommendations and action plans, collaborating with senior leaders as needed; driving team to research risk exposure data and prepare underwriting submissions in the areas insured risks, including general and professional liability and strategically guiding and holding team accountable for consulting on certificates of insurance, indemnification letters, and credentialing responses as they relate to insured risks, including general and professional liability programs; and managing determination, investigation, analysis, and resolution of potentially compensable events, compensable events, and regulatory investigations.


• Oversees Risk Management education and training by: managing development and implementation of a comprehensive, ongoing risk management-related training and education program for providers, staff, and/or external audiences; driving team to maintain advanced knowledge through training and development on risk management best practices and facilitating the integration of learning and feedback into work strategies across organizations; overseeing training evaluation methods and results and monitoring their sustainability; shaping risk management-related education and training across organizations to ensure alignment with organizational needs and industry trends; and partnering cross-functionally to ensure team serves as a resource and effectively disseminates information to providers, staff, and external partners across organizations on risk trends and avoidance.


• Manages Risk Management incidents by: managing and providing expert guidance in response to highly complex incidents, and development of response protocols; managing information gathering and investigation for highly complex incidents to determine impact and appropriate actions; holding team accountable for incident resolution and/or mitigation and providing guidance on highly complex escalations as needed; managing large-scale efforts to determine root cause(s) and driving organization-wide improvements and corrective actions to prevent recurrence; and ensuring facilitation of organizational awareness and handling of impactful clinical risk issues.


• Guides Risk Management programs by: driving implementation, planning, and development of comprehensive integrated, locally-relevant and/or enterprise-wide risk reduction and prevention programs; driving teams to proactively plan for and conduct complex audits and analyses to evaluate Risk Management programs; and overseeing, guiding, and promoting opportunities to develop and implement new programs and enhance existing ones based on analyses, observations, cutting-edge industry practices, and strategic organizational goals.


• Manages threat monitoring and risk prevention by: collaborating across organizations to manage collection and analysis of data from multiple reporting systems, sources, and emerging industry trends to identify opportunities to improve risk and threat management; holding team accountable for analysis, validation, and interpretation of new and ongoing threats and risks, facilitating partnerships with other functions (e.g., Quality Management, Patient Safety, Operations, Customer Service Call Center, Member Services, EH&S, and Security); ensuring teams delivery of expert technical consulting and analytical support to a comprehensive risk financing program preserving corporate assets in order to reduce the impact of financial loss in the areas of property, casualty, workers compensation, general liability, and professional liability; holding teams accountable for risk and threat response, including developing criteria for events which trigger immediate notifications and mitigation, and designing processes to address identified problems; driving the review and analysis of high-level product safety risks; driving preparation of initial processing and receipt of clinical / safety events; and providing highly advanced risk management expertise to support the reduction of preventable errors in health care delivery.