Easter Seals Jobs

Job Summary:

The Chart Operations team at Kaiser Foundation / Health Plan (KF /HP) is responsible for retrieving medical records for patients post visit and evaluating risk adjustment coded data to accurately capture the risk profile of members and ensure appropriate care delivery. As the VP of Chart Operations, you will report to the SVP of Risk Adjustment. You will lead a large team and coordinate across internal and external stakeholders, including analytics, provider groups, markets, vendors and health plan stakeholders. You will be responsible for oversight of all functions within the Chart Operations team, including chart retrievals, coding and validation, and vendor management and reporting. A key capability for this role is includes fostering robust communication channels and collaborative relationships across the organization and the network to maintain organizational alignment and regulatory compliance.

Essential Responsibilities:

• Program Management:

• Lead the development and implementation of programs and initiatives to drive post-care chart reviews, streamline vendor management, and improve coding accuracy

• Encounter Submissions and Audits:

• Lead teams in management for Center for Medicare and Medicaid Services (CMS) encounter submission and auditing processes

• Vendor Collaboration and Management:

• Foster robust collaboration and feedback loop with vendors and providers to ensure alignment with organizational goals and regulatory requirements and develop long term vendor strategy across all KF / HP markets.

• Encourage relationships and feedback loops between internal overread teams and vendor to report feedback and trends on vendor completed chart reviews

• Data and Reporting Transparency:

• Ensure data access and availability across all risk adjustment teams and stakeholders such as regulatory bodies and providers.

• Socialize reporting on performance and compliance metrics across the organization to ensure stakeholder awareness of trends and opportunities for program improvement.

• Data Submission Support:

• Develop and implement initiatives to continuously improve data submission processes.

• Specifically, helping teams identify areas to streamline processes and reduce submission turnaround times.

• Long Term Program Strategy:

• Develop and implement innovative Chart Operations strategies that align with organizational goals and regulatory requirements.

• People Management:

• Oversee a team of 70 FTEs and demonstrate ability to manage multiple team priorities and capabilities simultaneously

• Program Improvement:

• Foster a culture of continuous improvement, encouraging team members to contribute ideas and solutions for enhancing operational processes.

• Regulatory Tracking:

• Monitor CMS and market-specific requirements to ensure program compliance with regulations.

• Risk Management and Timeline Oversight:

• Identify and mitigate risks within the team and with the vendor in a timely manner and ensure team is meeting timeline expectations for submissions

• Stakeholder Relationships:

• Engage and maintain relationships with provider network, CMS and other regulatory stakeholders for accurate and seamless encounter submission processes

• Risk Management and Timeline Oversight:

• Identify and mitigate risks within the team and with the vendor in a timely manner and ensure team is meeting timeline expectations for submissions

• Program Improvement:

• Foster a culture of continuous improvement, encouraging team members to contribute ideas and solutions for improving operational processes through data driven findings.

Basic Qualifications:

Experience

• Minimum ten (10) years of experience in risk adjustment within a large health plan and Chart Operations within the healthcare sector, with a proven record of leading teams to success.

Education

• Masters degree in healthcare administration, Business Administration, or a related field.

License, Certification, Registration

• N/A

Additional Requirements:

• Solid understanding of federal and state healthcare regulations specifically, CMS requirements for submissions, Risk Adjustment timelines, reporting requirements, and the demonstrated ability to navigate and apply these standards within KF/HP operations

• Chart Operations Leadership: Demonstrated ability to lead end-to-end Chart Operations, including chart retrieval, HCC coding and chart review, overreads, and quality and validation processes

• Project Management: Experience managing teams of similar size (30-45 FTEs) and managing timelines, resources, and stakeholders. Proven track record in overseeing complex projects within the risk adjustment space and driving them to successful completion.

• Strategic Vision: Extensive experience in Risk Adjustment and Chart Operations with the ability to formulate and implement executive strategies that align with organizational objectives.

• Communication Expertise: Superior communication skills, essential for frequent interactions with vendors, providers, and other relevant stakeholders. Ability to convey complex information clearly and persuasively.

• Vendor Management: Substantial experience in managing vendor relationships, ensuring alignment and collaboration to support risk adjustment initiatives effectively.

Preferred Qualifications:

• Advanced degrees or relevant certifications are advantageous.

COMPANY: KAISER

TITLE: VP, Retrospective Chart Review Operations

LOCATION: Oakland, California

REQNUMBER: 1322153

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, 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.