Job Summary:
The Executive Director, Coding Operations is responsible for strategic initiatives, planning, program development, talent management and overall administration for Kaiser Permanente’s (KP) Facility and Professional Services Coding Operations at a national level. This position is accountable for developing the future state infrastructure to support standardization of processes and technology enablers to establish a leading practice coding operations program for KP’s fully integrated geographically dispersed multi-regional health system. The coding function is a key component of the revenue cycle and has direct impact to the collection of $3.5-$5 billion in annual revenues. This role will work closely with Revenue Management leadership and other Senior Leaders to meet the innovation challenges and opportunities of maintaining performance and quality metrics within a highly complex multi-region health system while transforming structures and systems to meet new demands of an integrated national coding operations. Reporting to the Vice President of Revenue Integrity this position will shepherd the coding operations infrastructure through implementation of standardized practices, and enhanced technology platform for coding operations. This position will oversee and manage an annual budget of approximately $115-$120 million and lead a nationally dispersed team of approximately 800-1,000 FTEs (direct and indirect reports; union and non-union employees).
Essential Responsibilities:
Primary Functional areas that report to the role include: Facility Coding, Professional Services Coding, and other Coding functions. Accountable for enhancing existing practices and thought-leadership for the effective and efficient Coding Quality Assurance, Coding Training & Education, and Coding Business Support on a National level. Accordingly, the Executive Director, Coding Operations is responsible for the following:
Define the vision, goals and objectives for a National Coding Operations within a fully integrated large multi-region, high-volume healthcare system for inpatient, outpatient, and professional coding
Lead standardization, development, and implementation of innovative national coding solutions to improve coding quality, productivity, enhance compliance, and end-user experience
Lead strategic planning and annual business planning for Coding Quality Assurance, Training & Education, and Business Support to align with the overall coding operations and Revenue Management strategic goals and objectives
Provide overall strategic, financial, and operational leadership for coding operations and develop and monitor the budget and operational plan to achieve organizational goals and objectives
Develop key performance indicators (KPIs) to monitor performance on coding quality, accuracy, and completeness.
Provide information and reports to Revenue Cycle leadership and National and Regional CFOs to facilitate strategic decision making and planning
Lead development and implementation of policies and procedures, workflow standards, and baselines to ensure a consistent framework for national governance of a multi-region, multi-faceted health system
Oversee all aspects of the development and implementation of national compliance, training and education, quality assurance programs, policies and procedures, and leading practices across coding operations
Ensure all areas of daily coding operations are updated and compliant against all applicable regulatory changes and requirements, as well as with all applicable KP policies and procedures in a timely and effective manner
Establish and actively maintain relationships with customers (internal and external) to ensure a service oriented, high quality operational and support environment for all coding systems and departments
Oversee the planning, implementation, and execution of service level agreements, budgets, and workflow processes that achieve strategic objections / business goals while meeting quality and compliance requirements
Chair the Coding Operations Steering Group (Compliance, Health Plan executives and Revenue Management leadership) to provide support and consultation, as required, to help drive performance, prioritize organizational initiatives, facilitate issue escalation and resolution, and decision making
Responsible for gathering input to inform Coding Operations governance supporting alignment and consensus across stakeholder groups (e.g., PMG, CDI, HP Region, CFOs; communicates and partners with Compliance, Risk Adjustment and Revenue Management leadership to disseminate decisions and status through appropriate channels.
Establish and develop working relationships with internal (KP) stakeholders (e.g., PMG, National Compliance Office, PFS, HP CFOs) requiring strong/effective collaboration to achieve Coding Operations strategic and business goals
Foster a positive, supportive and inclusive work environment with clear strategies, plans and objectives for: business goal attainment, ongoing coding improvement, excellence in performance and quality aligned with national standards
This position has a target base salary of $229,500 to $286,825 and is eligible for incentive compensation, comprehensive health, wellness, time off, savings, and retirement benefits, as well as relocation support, as applicable.
Basic Qualifications: ExperienceMinimum eight (8) years of senior coding leadership experience and/or five (5) years of direct leadership experience in providing physician education and coder education.
Minimum eight (8) years of experience in medical coding with thorough knowledge of CPT and ICD - 10 coding principles.
Minimum three (3) years chart reviewer/quality assurance reviews experience.
Education
Bachelor-s degree in Healthcare Information Management, or related field. License, Certification, Registration Certified Professional Medical Auditor OR Certified Risk Adjustment Coder OR Registered Health Information Administrator OR Certified Professional Coding Instructor OR Certified Coding Specialist - Physician Based OR Registered Health Information Technician OR Certified Professional Coder Additional Requirements:
Experience managing a large multi-regional health system coding pool and/or coding reviewer pool for inpatient, outpatient, and physician servicesKnowledge of medical terminology, disease processes and pharmacologyKnowledge of CMS regulatory rules and coding guidelinesStrong communications (written/verbal) and presentation skills Proven influencing skills with proven ability to lead organizational change efforts. Preferred Qualifications:
Masters degree in Healthcare Information Management, Business, Nursing or related field10+ years of management consulting or coding senior leadership experience and/or 7+ years of leadership experience in providing physician education and coder educationProven work experience in areas of process transformation, process re-engineering, shared services, change management and project managementPrevious experience using or optimizing EPIC or similar enterprise-wide revenue management technology/systems.