Senior Manager - Revenue Cycle Compliance Program

Working under the direction of the Compliance & Privacy Officer adheres with KP Compliance Framework, fosters comprehensive compliance projects through a series of activities to comply with all applicable regulations and statutes. Provides professional/technical guidance to team member and employees at large and presents complex information throughout the organization. Impacts the achievement of key functional and/or KP objectives that have direct and significant business impact.

Contributes to the development of the departments objectives and participates in the development of the annual risk assessments, work and audit plans. Could have a primary functional area of emphasis in one or more of these areas: Investigations, Scope of Practice, Privacy, Health Information Management/Coding, Revenue Cycle, External or Internal Auditing or Statistical Analysis. Responsible for strategic projects that set and define the direction of the compliance organization.

• Project Planning: Manages the identification of compliance accountabilities for local/regional compliance programs and internal and external resources. Develops and executes annual compliance work and audit plans. Strategically sets Compliance goals, timelines approaches and strategies in support of organizational initiatives. Develops strategy and leads compliance related committees/work groups and manages external relations. Cultivate and reinforce appropriate group values, norms and behaviors. Champions innovation and change though identification of areas of performance improvement and establishment and/or delegation of resources to lead compliance-related projects. Demonstrates resource stewardship in on-going efforts to establish, identify & manage internal/ external resources and relationships. Demonstrates resource management on work of external consultants as needed. Viewed as expert in compliance by internal and external customers. Exerts influence when directing or consulting as subject matter expert (SME) for NCAL Region.


• Investigations: Strategizes and collaborates when directing the administration of investigation processes and activities. Leads the identification of compliance requirements and directs/creates related analyses. Sets strategy in efforts to identify potential compliance issues and areas of compliance requirements. Sets strategy for the creation and revision of compliance standards, policies, and procedures. Establishes framework for monitoring of compliance adherence and reporting on compliance efforts and programs. Manages a collaborative environment with other functional areas in investigating potential compliance issues and risks. Develops relationships and collaborates with KP Legal to assist in interpreting and gauging the impact of laws and regulations. Establishes framework and directs creation of templates and timelines in the development of project plans and other initiatives. Establishes framework for monitoring corrective action plans. Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization and across entities are being appropriately evaluated, assessed and maintained. Collaborates across entities in response to alleged violations of rules, regulations, policies, procedures, and standards of conduct by evaluating or recommending the initiation of investigative procedures. Develops and provides reports on a regular basis, and as directed or requested to keep Leadership informed of the operation and progress of compliance efforts. Ensures proper reporting of violations or potential violations to Leadership across entities.


• Validation: Oversees the administration of compliance programs and content, including leading design and implementation, of risk assessments and/or audits. Oversees investigation processes & activities and instances of reported non-compliance. Manages compliance risks and develops related Corrective Action Plans, assesses completion rates & operational sustainability. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Develops communication strategies to address impacts and required changes.  Identifies and delegates resources to support risk assessment and implementing required changes. Researches and stays abreast of regulations and statutes exhibiting extensive knowledge on a wide variety of clinical and non-clinical compliance issues. Exerts influence and engages external regulatory and legislative bodies and trade associations on developing regulations and laws, providing input and representing Kaiser Permanente's interests. Viewed as expert in compliance by internal and external customers.


• Implementation: Influences and manages staff to ensure compliance and reporting on compliance efforts and programs. Identifies and implements OIG compliance requirements. Leads the identification of compliance requirements and sets direction for related analyses. Directs and performs on-going assessment of established solutions to existing alternatives and exerts influence by making recommendations as needed to implement changes. Develops framework and strategies in the creation, revision & development of compliance standards, regulatory compliance, and policies and procedures - not limited to privacy and security, fraud, waste and abuse, non-retaliation, disciplinary action, vendor relations etc. across all levels of the organization. Directs compliance adherence and reporting on compliance efforts and programs to all levels of the organization.


• Program Management: Leads change management efforts in service areas as well as larger departmental goals or objectives. Identifies and acts upon opportunities to leverage direct reporting team in change management activities; ensures direct reporting team is engaged in change management as appropriate; and enables team members to develop and improve skills/capabilities that support departmental goals. Anticipates issues through regular communication with reporting positions and other internal and external parties, mitigating risk or escalating issues for resolution by more senior levels as necessary. Leads issue management, response, and mitigation across service areas/entities.


• Proactively identifies risks and issues related to Compliance. Facilitates communications, manages relationships with stakeholders, and negotiates agreement from involved parties for compliance initiatives and programs across all levels and Regions of the organization/entities. Leads by example and enables team members to develop and improve skills/capabilities that support departmental goals. Works on significant and unique assignments of diverse and complex scope. Leads efforts and/or addresses opportunities for process improvements and influencing change across all levels of the organization/entities. Thinks and acts strategically when planning and directing diverse and multiple stakeholders across all levels of the organization/entities.


• Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.