[Hiring] Compliance Consultant V, Medical Coding - Risk Adjustment @Kaiser Permanente

Role Description

Support Health Plan Risk Adjustment operations through government audit readiness, compliance oversight, and internal quality assurance reviews. Perform coding validation, documentation review, and data-driven analysis to ensure accurate risk capture, regulatory compliance, and coding integrity. Partner with operational, clinical, and compliance teams to identify risks, improve coding quality, support audit activities, and drive continuous improvement across Risk Adjustment programs.

In addition to the responsibilities listed below, the position is responsible for serving as a compliance subject matter expert related to functions within all settings of care, maintaining compliance with national coding policies and procedures, assisting with coding questions and related topics, and auditing and monitoring the quality of coding assignments across all lines of business. Additionally, this position is responsible for developing and presenting audit result reports to regional staff and senior management and supporting compliance and the Principles of Responsibility (KPs code of conduct).

Essential Responsibilities

• Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders.
• Communicates information and provides advice to drive projects forward; influences team members within assigned unit.
• Listens and responds to, seeks, and addresses performance feedback; adapts to competing demands and new responsibilities.
• Provides feedback to others, including upward feedback to leadership and mentoring junior team members.
• Creates and executes plans to capitalize on strengths and develop weaknesses; adapts to and learns from change, difficulties, and feedback.
• Conducts or oversees business-specific projects by applying deep expertise in subject area.
• Promotes adherence to all procedures and policies; develops work plans to meet business priorities and deadlines.
• Determines and carries out processes and methodologies; coordinates and delegates resources to accomplish organizational goals.
• Partners internally and externally to make effective business decisions; solves complex problems; escalates issues or risks as appropriate.
• Monitors progress and results; recognizes and capitalizes on improvement opportunities; evaluates recommendations made by others.
• Conducts company compliance activities by partnering with internal and external stakeholders.
• Applies established regulations and standards to compliance efforts; designs, develops, and executes strategic compliance initiatives.
• Analyzes regulations and regulatory changes, and their application to operations; documents compliance activities.
• Leads compliance reporting efforts by evaluating and summarizing compliance data, audit information, and potential risks and remedies.
• Identifies and reports key compliance drivers, liabilities, and performance indicators to management.
• Develops presentations to convey key findings to management and other key stakeholders.
• Leads compliance investigations by coordinating the collection and analysis of quantitative and qualitative data.
• Leads interviews as appropriate; researches key business issues; identifies potential action steps.
• Evaluates and recommends corrective action plans for substantiated allegations.
• Manages projects or compliance components of larger cross-functional projects by identifying and managing stakeholder contacts.
• Assembles teams based on project needs and team member strengths; develops, analyzes, and manages project plans.
• Negotiates and manages project schedules and resource forecasts; manages project financials and deliverables.
• Drives regulatory compliance by monitoring and interpreting complex regulatory changes.
• Leads analysis on regulatory impacts; oversees the implementation of designated changes.
• Drives the implementation of compliance efforts by identifying compliance requirements.
• Leads the assessment of current state compliance to identify gaps and corrective actions.
• Creates or revises complex compliance standards, policies and procedures, and training.
• Monitors ongoing compliance adherence.

Qualifications

• Minimum six (6) years medical coding experience.
• Minimum three (3) years experience in a leadership role with or without direct reports.
• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.
• Minimum eight (8) years experience in health care compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field.
• Additional equivalent work experience in a directly related field may be substituted for the degree requirement.
• Certified Coding Specialist from American Health Information Management Association OR Certified Risk Adjustment Coder from American Academy of Professional Coders OR Certified Professional Coder from American Academy of Professional Coders.