Description

Overview: The Clinical Risk Adjustment Coder plays a key role in ensuring accurate and compliant coding within a risk adjustment framework. This position involves applying deep expertise in RA coding, working within Epic systems, and aligning coding practices with provider workflows. The role will support clinical documentation improvement efforts by translating clinical information into precise coding that reflects the complexity of patient care.

Job Summary:

Facilitates strategy development by defining moderately complex business problems and opportunities and identifying, weighing, and recommending alternative approaches. Performs moderately complex analysis and ensures interpretation of market data and tests hypotheses using advanced knowledge of qualitative and quantitative analytical tools to drive towards insightful and actionable insights for the business. Assembles moderately complex proposals for projects and programs to ensure progress on deliverables and effective execution to produce high-quality business outcomes. Ensures implementation of updated processes to improve Return on Investment (ROI), service quality, and operations for initiatives across teams. Fosters collaborative partnerships with inter/intraorganizational and external partners and builds and develops trusting relationships with key stakeholders.

Essential Responsibilities:

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Analyzes and interprets market data by: developing and implementing a plan to address moderately complex research questions and test hypotheses with advanced knowledge of data collection and analysis; performing moderately complex quantitative and qualitative analyses and investigating alternative hypotheses; and ensuring interpretation of key findings, conclusions, and recommendations for the future.
• Facilitates process improvement efforts by: ensuring the implementation of updated processes and beginning to identify opportunities to adapt processes to improve return on investment (ROI), operations, service quality, and results for initiatives across teams; utilizing moderately advanced knowledge of business operations to ensure the implementation of best practices across teams; and encouraging adoption of best practices and future innovations.
• Effectively manages projects and programs by: assembling project moderately complex proposals, including establishing objectives, key stakeholders, milestones, projecting required resources and timelines; ensuring progress on project deliverables in alignment with greater business strategy across a function; utilizing existing methodologies to complete initiatives with little support; and ensuring the execution of project plan, contributing to high-quality outcomes.
• Proactively maintains open streams of communication by: building and developing trusting relationships with stakeholders by navigating the organizational landscape; identifying moderately complex issues or risks to strategic program implementation and ensuring that they are resolved or escalated; fostering collaborative partnerships with inter/intraorganizational and external partners to develop and refine key priorities and strategy; and proactively communicating strategic issues and recommendations to senior leadership and across their function.
• Contributes to the development and execution of business strategy by: developing moderately complex strategic proposals based on business case and advanced knowledge of health care marketplace; assessing the scope of the problem to be addressed and the resources needed; identifying strategic options based on problem scoping; recommending challenging business goals and the processes and resources needed to accomplish them; ensuring alignment around the strategic plan and intended outcomes, and finding opportunities for collaboration and synergy within a function; ensuring application of strategies to mitigate moderately complex barriers, constraints, and risks to execution; and assessing and adjusting strategic direction in response to a changing environment.

Minimum Qualifications:

• Minimum two (2) years of experience in project management, forecasting, planning, consulting, strategy development and/or execution, or a directly related field.
• Bachelors degree in Business, Health Care Administration, Public Health Economics, Finance, or related field AND minimum four (4) years of experience in strategic planning, strategy facilitation, execution of large-scope strategic projects or directly related field OR minimum seven (7) years of experience in strategic planning, strategy facilitation, execution of large-scope strategic projects or a directly related field.

Additional Requirements:

• Knowledge, Skills, and Abilities (KSAs): Business Acumen; Applied Data Analysis; Financial Market Research; Business Relationship Management; Project Management; Risk Assessment; Time Management

Preferred Qualifications:

• One (1) year of experience working in a large matrixed organization.
• One (1) year of Health Care experience.

Primary Location: Maryland,Fulton,Maple Lawn Call Center

Additional Locations:

• Oakland
• Pasadena
• Denver
• Portland
• Atlanta
• San Diego
• Sacramento
• New York
• Chicago

Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Po/Ho Corp - Medicare LOB Admin - 0308
Pay Range: $128500 - $166210 / year Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente. Travel: Yes, 10 % of the Time Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
Requisition #: 1389255

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