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Job Details

Compliance Consultant IV Risk Adjustment

Location
Pasadena, CA

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Pasadena
California
The primary responsibility of the Compliance Consultant IV (CC IV) is to help manage, create and maintain relationships with the risk adjustment communities. The CC IV need to have a detailed understanding of the end to end processes of the encounter data development and submissions that is critical to risk adjustment. The position will require the ability to perform data analytics, causal factor analysis, design, develop and maintain dashboards for leadership reporting. In addition, the CC IV will be responsible for researching any new regulatory updates and/or changes and will communicate to the risk adjustment communities.
Researches, plans, implements, and monitors a broad portfolio of compliance systems and initiatives to enable organizational compliance with all applicable Federal, state, and local regulations/laws, as well as overseeing the protection of organizational assets. On an on-going basis, researches and interprets regulations and laws to establish compliance standards, and may develop and/or deliver training and communications/change management relative to new standards. Assesses organizational systems (both physical and process or data related) to determine gaps in compliance and determine opportunities for remediation. Advises the organization on all compliance matters. May investigate violations of compliance policy, laws, regulations, etc. or conduct on-going monitoring and reporting to ensure remediation. May be responsible for project management relative to new compliance initiatives, products, or annual processes.
Essential Functions:
Manages, creates, and maintains client relationships.
In adherence with the KP Compliance Framework, fosters comprehensive compliance management through a series of activities to comply with all applicable regulations and statutes. Activities include: Planning: Identifying and may lead the identification of compliance accountabilities; identifying and may lead the identification of internal and external resources; developing and/or overseeing the development of Compliance, Work, and Audit plans; participating on and may establish compliance-related committees/work groups; and managing external agency relations.Implementing: Identifying compliance requirements and conducting related analyses; creating or revising compliance standards, policies, and procedures; developing and/or conducting compliance and ethics training; monitoring compliance adherence; and reporting on compliance efforts and programs, and Validating: Reviewing compliance programs and content, including designing and conducting risk assessments and/or audits, and investigating instances of reported non-compliance.
Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Communicates required changes, develops tools to assess risks, and leverages existing workgroups/etc. to facilitate required changes.
Basic Qualifications:
Experience
Minimum eight (8) years of health care compliance, health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience.
Education
Bachelor's or clinical degree, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A.
Additional Requirements:
Advanced knowledge of health care compliance policies, practices and systems.
Advanced knowledge of health care and related compliance issues.
Contributes to the development of compliance principles, theories, and concepts.
Broad knowledge of health care industry practices and standards.
Ability to draft and revise documents including policies, standards, analyses, and reports.
Project management skills.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Risk adjustment compliance experience
COMPANY: KAISER
TITLE: Compliance Consultant IV, Risk Adjustment
LOCATION: Pasadena, California
REQNUMBER: 692874
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.

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