340bemployed.org

JOB SUMMARY

The Director, Documentation and Reporting Program is responsible for providing strategic leadership, direction, and oversight in achieving WPMG's Documentation and Reporting goals, in partnership with other affiliated KP PMGs. The position works collaboratively with the Medical Director, Documentation and Coding, and KFHP/W departments and PMG counterparts in affiliated regions to develop, coordinate, and monitor the appropriate and accurate capture of patient care; including services and diagnoses, by physicians and other clinicians, both in Care Delivery and the contracted network. In addition, the Director has expert understanding of the interdependence of accurate reporting with Quality, Compliance, benefit assessment, as well as the revenue cycle and risk adjustment teams. The Director oversees a team of resources (that may be based in other regions) who have primary accountability for a functional area which may include: monitoring, data mining, clinician & staff education, benefits assessment and implementation, and systems & applications support.

PRINCIPAL DUTIES & RESPONSIBILITIES

Responsibility

*

• Serves as a Documentation and Coding expert, in partnership with other PMG Program Directors, advising WMPG Executive Leadership on all Risk Adjustment Plans, Revenue Cycle issues, Benefit Assessment and Implementation and other complex healthcare issues of strategic importance.
• Partnering with the Medical Director, provides leadership and direction in accordance with the overall strategic operational goals of WPMG, working to achieve consistency with other KP Program standards for documentation completeness and accuracy.
• Leads PMG efforts regarding risk adjustment (Medicare, Medicaid, Affordable Care Act, Commercial risk adjustment) for Care Delivery and contracted network provider groups.
• Actively monitors operational and financial performance to anticipate and meet the needs of leadership.
• Monitors KP implementation of risk adjustment in the commercial sector including the small group and individual market (in and out of the Exchange) and large groups and escalates any findings and concerns as appropriate
• Applies thorough understanding of key business processes to effectively anticipate and address long-term implications of decisions and actions.
• Participates in collaborative goal setting and strategic planning with key stakeholders.
• Partners with other departments and teams to support and champion initiatives. Examples include: Quality, Compliance, Revenue Cycle, Finance, Benefits Administration, Epic (electronic medical record), Training and Education.
• Fosters a positive and pro-active work environment, emphasizing respect for individuals, high standards of quality, customer service, innovation and team work.
• Effectively communicates leadership messages, models leadership behaviors and supports change management.
• Responsible for leading a team fostering a strong results orientation by motivating staff and holding them accountable to meeting service, quality and, operational goals.
• Other duties as assigned.

EDUCATION

REQUIRED

DESCRIPTION

PREFERRED

Minimum:

Minimum of 10 years' experience in healthcare consulting and/or medical group business functions or operations including risk adjustment, documentation and coding, revenue cycle and associated functions.

Minimum of 5 years' experience leading a team with direct supervisory responsibilities. Proven success in medical group management, including leadership experience in implementing large scale change.

REQUIRED

DESCRIPTION

PREFERRED

Minimum:

KNOWLEDGE/SKILL

DESCRIPTION

REQUIRED/PREFERRED

Expertise

• Knowledge of multi-specialty group practice network contracted provider groups, health plan, and medical center operations.
• Knowledge and expertise in documentation and coding requirements; demonstrating subject matter level of expertise.
• Expert knowledge of Federal rules and regulations regarding documentation and coding.
• Demonstrated effective problem solving, analytical, and decision-making skills.
• Proven negotiation and conflict resolution skills.
• Excellent communication and presentation skills (oral and technical)--the ability to take complex problems, assess and describe them, and communicate solutions.

Required

Management

• Demonstrated leadership skills with the ability to direct the activities of others on a direct or matrix team basis.
• Ability to collaborate and be influential across structures and roles.
• Ability to facilitate and lead organizational decision-making processes
• Ability to challenge established ways and lead change.

Required

Relationships

• Builds productive rapport with employees at all levels within and outside the department.
• Treats others with fairness, dignity, and respect.
• Accepts suggestions and criticism in a cooperative and positive manner.
• Works collaboratively with team members and others to achieve identified goals and objectives.
• Ability to work effectively across organizations, departments, and teams.
• Establishes and maintains good working relationships with both external and internal customer.
• Interacts with others in a helpful and informative manner.
• Capable of resolving conflict.

Required

Service Excellence

• Understands and responds promptly and courteously to customer needs and expectations.
• Follows through to see if customer needs were met and keeps them informed of status.
• Timely when responding to voicemail, e-mail and interoffice communications.
• Expresses ideas clearly and accurately both orally and in writing.
• Encourages, respectfully listens to and acknowledges diverse points of view.
• Treats all customers with courtesy and respect.
• We are professionals serving professionals.

Required

Management

• Ability to collaborate and be influential across structures and roles.
• Ability to facilitate and lead organizational decision-making processes

Required