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VP of Revenue Management Compliance

Company: Healthcare/Hospitals/Clinics, Oakland, CA
Location: Oakland
Posted on: December 9, 2018

Job Description:

Description: The VP, Revenue Management Compliance is responsible for establishing and implementing an effective compliance program to support compliance with state and federal laws and regulations, as well as Company Foundation Health Plan and Company Foundation Hospital policies and procedures relating to coding, documentation, risk adjustment, revenue cycle, and reimbursement activities. This includes effectively identifying, managing, investigating, and mitigating revenue management risk across the enterprise, and communicating results to for Company compliance and operations leadership. This position reports directly to the Chief Compliance and Privacy Officer and is a member of the National Compliance Senior Leadership Team.

Essential Responsibilities: Leadership and Management: Participating as a member of the National Compliance Senior Leadership Team. Aligning with and carrying out the overall ethics and compliance program strategy within the activities of the revenue management compliance team. Providing executive leadership, direction and management of the revenue management compliance team. Building a strong team of individuals who are subject matter experts in revenue cycle and risk adjustment compliance and who effectively work cross-functionally to carry out the compliance program. Revenue Management Compliance Program Effectiveness: Proactively leading efforts for the identification and mitigation of revenue management compliance risk, including coding, billing, risk adjustment, encounter reporting, documentation, and reimbursement. Implementing an effective risk assessment that informs the revenue management compliance work plan. Ensuring appropriate training and awareness of revenue management compliance risk is provided to key stakeholders and monitoring participation in revenue management compliance training programs. Partnering with revenue management stakeholders to create and implement revenue management compliance policies and procedures. Implementing a robust monitoring and auditing program that adequately monitors the compliance risks inherent in risk adjustment and revenue cycle business activities. This will include, but not be limited to, coding audits, documentation review activities, billing review activities, as well as monitoring new and evolving regulations that impact revenue management operations and collaborating with relevant stakeholders to ensure appropriate implementation, compliance, and ongoing monitoring. Providing leadership over government audit support, coordination, and trend analysis, including managing the Risk Adjustment Data Validation (RADV) audit process and other similarly related audits. Conducting and overseeing the resolution of all revenue management compliance investigations. Overseeing and managing required repayments of government reimbursement to ensure compliance with regulations. Creating and implementing revenue management risk reporting metrics and communicating results to key stakeholders. Collaboration with Stakeholders: Significant collaboration and communications with operations executive stakeholders, including the national and regional Revenue Management operations leaders. Collaborating with the Permanente Medical Groups to support activities that ensure accurate and complete documentation and physician coding. Leading efforts with the Regional Compliance Officers to ensure that the revenue management compliance function is effective in the regions. Serving as a subject matter expert and authoritative resource to align the interpretation and application of all revenue management compliance matters, including documentation and coding rules and regulations. Serving as the compliance executive representative on the CDI/Coding Operational Steering Committee, as well as the Risk Adjustment Operational Steering Committee and providing guidance, support and direction to such committees on revenue management compliance related matters. Communicating to the Chief Compliance and Privacy Officer compliance matters impacting revenue management. Consulting with Internal Audit Services to develop audit plans that incorporate relevant revenue management compliance standards. Basic Qualifications: Experience Minimum ten (10) years of escalating managerial work-experience in a highly diversified organization. Minimum ten (10) years of escalating responsibility and work-experience in a health care compliance field or other relevant healthcare experience (internal audit, law, etc.); to include progressive management roles in large, complex organizations with successive levels of accountability and results. Education Bachelor-s degree.

Keywords: Healthcare/Hospitals/Clinics, Oakland, CA, Oakland , VP of Revenue Management Compliance, Executive , Oakland, California

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