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Director, Coding Quality Assurance (QA) Systems

Primary Location Oakland, California Schedule Full-time Shift Day Salary $192200 - $248710 / year
Job Number 1367906 Date posted 07/08/2025
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Job Summary:


The Director is the Business Application Owner (BAO) for all coding quality assurance tools. Position is responsible for coding QA metrics and trend analysis. Position oversees coding QA recovery initiatives, QA tool machine learning as well as its automation initiatives. Has oversight and responsibility for all Coding QA systems in alignment with KPIT, Coding Operations, and CDI, including regulatory research and metrics. Will monitor and report on key performance indicators (KPIs), providing regular updates and recommendations for workflow improvements. Lead initiatives to improve the quality of coding through machine learning and automated processes.



Directs the delivery of large-scale programs or components with multiple workstreams and strategic business goals across departments, functions, or regions with responsibility and accountability for achieving program outcomes from initiation to close-out in an extended or open-ended time frame. Directs programs team, holding the team accountable for results, and oversees the decisions of others regarding internal and/or external resource requests. Proactively monitors, identifies, and mitigates risks, issues, and trigger events within and across multiple interdependent programs by leveraging expertise and recommending changes. Directs compliance of program activities by ensuring program plans and team members adhere to relevant policies and procedures. Directs the alignment, buy-in, engagement and support of diverse program stakeholders. Oversees vendor performance, provides direction for service improvements, and directs partnerships and contract negotiations with vendors.



Essential Responsibilities:


  • Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact.

  • Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and / or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.

  • Directs the delivery of large-scale programs or components with multiple workstreams and strategic business goals across departments, functions, or regions with responsibility and accountability for achieving program outcomes from initiation to close-out in an extended or open ended time frame. Reviews program plans and determines program demands for the most complex program initiatives in order to identify and manage scope, and supply appropriate staffing to complete program plans within scope, budget and schedule. Oversees the program financials of large, high profile, dynamic program initiatives and ensures they are managed within budget allocations. Reviews performance across a portfolio of programs to ensure programs effectively deliver maximum long term value or benefit to the organization, and makes adjustments as needed in an uncertain environment where scope may be fluid. Develops and disseminates processes and procedures for the development and execution of organizational change management (e.g., user adoption, implementation, and training plans). Establishes and oversees proper program management practices in regard to allocation of resources, schedules and task assignments. This role may perform project management duties in addition to program management responsibilities.

  • Directs programs team and holds team ccountable for results. Oversees the decisions of others in reference to internal and/or external resource requests based on the alignment of team member skills and program demands. Leverages expertise to create a clear vision of overall program goals and objectives. Delivers performance feedback to team.

  • Proactively monitors, identifies, and mitigates program risks, issues, and trigger events across multiple interdependent programs by leveraging expertise and recommending changes to program processes based on the analyses and identification of trigger events.

  • Directs adherence of program activities to policies and procedures by ensuring program plans and team members follow KP, departmental, and/or business line policies and procedures.

  • Directs the alignment, buy-in, engagement and support of diverse programs stakeholders to set long-term program goals by building and maintaining relationships as well as communicating appropriately with internal customers, third party vendors, executive management, and business leaders; and clarifying accountability and authority across stakeholders. Builds close relationships with key stakeholders across multiple functions based on their level of influence and decision making and guides teams in identifying the right stakeholders for their programs. Directs programs goals, influences the prioritization of deliverables, coordinates all business processes (e.g. project change management, communication) and facilitates decisions necessary for programs delivery by partnering with programs sponsors and/or review boards. Communicates tough issues to stakeholders while maintaining an independent opinion, providing recommendations, delivering formal presentations, and providing reports to executive audiences. Engages with senior and executive stakeholders to identify long term value to the organization and define success.

  • Oversees vendor performance and provides direction for service improvements or revisions to strategy. Partners with Procurement and/or Legal to develop service level and/or scope of work agreements as appropriate. Directs partnerships and contract negotiations with vendors.

Minimum Qualifications:

  • Minimum six (6) years of experience in International Classification of Diseases (ICD)-10-Clinical Modification, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding, including chart auditing, applying diagnoses and/or procedure codes, and/or conducting coding reviews.

  • Minimum two (2) years of experience managing operational or project budgets.

  • Minimum three (3) years of experience in a leadership role with direct reports.

  • Bachelors degree in Business Administration, Health Information Management, Health Care Administration, Health/Health Care Informatics, or related field AND minimum eight (8) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field OR Minimum eleven (11) years of experience in health care compliance, health care operations (quality, risk), audit, insurance/health plan governance, coding, medical record review, or a directly related field.

  • Certified Coding Specialist within 12 months of hire OR Registered Health Information Administrator within 12 months of hire OR Certified Professional Coder within 12 months of hire OR Certified Coding Specialist - Physician Based within 12 months of hire OR Registered Health Information Technician within 12 months of hire
Additional Requirements:

  • Knowledge, Skills, and Abilities (KSAs): Information Gathering; Written Communication; Audits; Compliance Management; Health Care Compliance; Maintain Files and Records; Data Quality; Health Care Data Analytics; Technical Documentation; Trend Analysis; Execution Excellence; Stakeholder Management; Internal Audit Processes; Medical Terminology; Medical Coding; Health Information Systems; Quality Improvement; Quality Assurance and Effectiveness; Training
Preferred Qualifications:
  • Five (5) years of experience managing coding functions, including auditing, quality review, physician training, and coding guideline and policy development.
Primary Location: California,Oakland,1950 Franklin Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Remote Employee Status: Temporary Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee Job Level: Director/Senior Director Department: Po/Ho Corp - Revenue Management Core - 0308 Pay Range: $192200 - $248710 / year Travel: No

Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

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