Vice President, PMG Revenue Management

  • Kaiser Permanente
  • Oakland, CA, USA
  • Oct 08, 2019
Revenue Cycle

Job Description


Permanente Federation LLC (the Federation) is the national leadership and
consulting organization for the eight Permanente Medical Groups (PMGs), which,
together with the Kaiser Foundation Health Plans (KFHP) and Kaiser Foundation
Hospitals (KFH), comprise Kaiser Permanente. The PMGs employ almost 23,000
physicians, approximately 90,000 nurses, other clinicians and staff, and
provide care to over 12.2 million Kaiser Permanente members. The Federation
works on behalf of the PMGs to optimize care delivery and advance Permanente Medicine
- medicine that is patient centered, evidence based, technology enabled,
culturally responsive, team delivered, and physician led. The Federation, based
in Oakland, California, is dedicated to serving and leading Permanente
Medicine, the Permanente Medical Groups, and Kaiser Permanente in support of
our patients and members.

The Vice President of Revenue Management will provide leadership, strategic direction and guidance to the Permanente Medical Groups and Kaiser Permanente in the areas of Risk Adjustment, Coding Policy, and Revenue Cycle. Coordinates across areas including Government Relations, National Compliance Office (NCO), Finance, Convergent Medical Terminology (CMT) and KP HealthConnect (KPHC). Influences Kaiser Permanente risk adjustment policy development (both Medicare and ACA) including ICD, CPT, and identification of new services, such as telehealth. In addition, the Vice President will participate in KP comment development that influences the Federal agenda and policy re: risk adjustment and documentation and coding requirements. This position will regularly spend time in each of the PMGs to 1) gain a deep understating of opportunities and bright spots; 2) ensure each PMG has the appropriate resources, internal expertise, and skill sets and; 3) provide mentorship to each of the PMG teams. Advances this work on behalf of the Health Plan and PMGs through strong leadership and excellent communication skills.

Essential Responsibilities:
- Permanente Federation Vice President responsible for providing national PMG leadership for physician documentation and coding activities
- Consults with and leads the PMGs to ensure high levels of program performance in documentation and coding and (both completeness and accuracy)
- Leads the sharing and implementation of successful practices and learnings
- Leads and directs the Clinical Documentation and Reporting Group (CDRG); chairs or sponsors other related committees as necessary
- Co-Chairs (with NCO) the Kaiser Permanente Coding Governance Group (CGG), chartered to enhance the quality of coded clinical and administrative data by providing consistent policy, strategy, and direction for coding across Kaiser Permanente
- Works with the National Compliance Office and Federation Legal as needed
- Provides leadership and directs changes to the EDG Masterfile to support ICD10 and CPT annual updates or more frequently as needed
- Identifies need, and advocates for, coding modifications/additions to the federal ICD-10 Coordination and Maintenance Committee and AMA/CPT Editorial Panel as required
- Co-leads annual risk assessment process supporting auditing and monitoring programs. Leads implementation of PMG baseline monitoring plan
- Leads the strategy and development of training and communication tools in partnership with national quality leaders and documentation and coding leaders
- Identifies opportunities, and guides the implementation of initiatives to decrease unwarranted variation
- Permanente Federation Vice President responsible for risk adjustment and associated payment methodologies
- Provides leadership and expertise to PMGs/Regions regarding risk adjustment (Medicare, Medicaid, HealthCare Reform, Commercial risk adjustment)
- Leads and ensures implementation of any PMG operational changes necessary to ensure compliance with CMS standards and regulations
- Partners with Health Plan VP of Risk Adjustment to ensure clear understanding of payer risk adjustment requirements and other relevant laws and regulations
- Co-Chairs the Risk Adjustment Joint Committee along with the physician lead and HealthPlan VP of Risk Adjustment
- Partners with Government Relations, Legal, National Compliance, Finance, Revenue Cycle, Actuarial Services and other organizational functional areas to ensure comprehensive review of regulatory changes or new policy and understanding associated impacts to KP business and clinical operations
- Ensures that KPHC and CMT are informed of new requirements impacting internal systems; to incorporate changes necessitated by Medicare, Commercial, and ACA reimbursement policy and regulatory changes. Ensures/leads implementation as needed
- Actively engages with PMGs to determine strategies, priorities and investment for infrastructure and support of risk adjusted payment
- Sets pan-PMG goals for readdressing diagnoses and evaluating suspect diagnoses and monitors performance against goals - always looking both ways
- Works with Health Plan to lead and design data reconciliation process ensuring complete, timely and accurate submissions to CMS
- Identifies opportunities, and guides the implementation of initiatives to decrease unwarranted variation
- Permanente Federation Vice President for Revenue Cycle strategy, policy and overall performance
- Partners with Health Plan Revenue Cycle to provide PMG perspectives and insight on revenue cycle strategic opportunities
- Participates in key steering committees to assure PMG perspectives are represented (e.g. Paying for Care and Coverage Steering Committee)
- Supports the physician leader to ensure physician work flows support complete, timely and accurate billing (e.g., LOS, DX and procedure capture)
- Ensures new benefits can be operationalized by the PMGs and billed by Revenue Management
- Supports the physician leader to ensure physician work flows are payer agnostic
- Ensures all new care delivery models can be operationalized and billed (e.g. telehealth, pan-PMG initiatives etc.)
- Supports the physician lead with the Inpatient Clinical Documentation Improvement Program (CDI) - query selection and design, escalation process, physician feedback, communication and training
- Works with Revenue Management leadership to leverage new KPHC functionality to support efficient operations and to remain current with consumer expectations
- Stays current with industry benchmarks and best practices
- Works with Revenue Management leadership to identify causes of revenue breakdowns (e.g., credits, denials and unbilled services
- Identifies opportunities, and assists with the implementation of initiatives to decrease unwarranted variation

Basic Qualifications:
- Minimum fifteen (15) years of work experience with progressive levels of responsibility
- Minimum five (5) years of leadership and / or management experiences, in a health care setting
- Bachelor-s degree in finance, business, or related field
License, Certification, Registration
- N/A.

Additional Requirements:
- Extensive knowledge of the multi-specialty group practice model. Knowledge of Health Plan, clinic and hospital operations required.
- Proven success in executive-level leadership, including experience in implementing large scale change.
- Deep knowledge and expertise in health information and payment policy.
- Strong knowledge of Federal rules and regulations regarding documentation, coding and risk adjustment.
- Ability to work independently to further the vision of The Permanente Federation, the Permanente Medical Groups and Kaiser Permanente as a whole.
- Demonstrated ability to lead and manage a team.
- Exceptional analytic, conceptual, and business planning skills.
- A proven track record of results in working with process management.
- Demonstrated ability to work effectively with physicians and other professional leaders through influence and collaboration.
- Outstanding leadership and communication skills.
- Demonstrated experience in successfully managing complex organizational initiatives and change efforts in matrixed organizations.
- Superior communication, consulting, facilitation, negotiation, conflict management, problem resolution, and consensus building skills.
- Excellent written/verbal presentation and listening skills, and the ability to present complex information in a clear and concise manner to a variety of audiences.
- Proven ability to provide professional/technical guidance to stakeholders.
- Superior organizational and planning skills.
- Demonstrated ability to foster a culture of innovation.

Preferred Qualifications:
- Master's degree preferred.

Primary Location: California,Oakland,Ordway One Kaiser Plaza Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon-Fri Working Hours Start: 8:30 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Consulting Services / Project/Program Management (Non IT) Department: Fianance Travel: Yes, 25 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.