VP, Retrospective Chart Review Operations

The Chart Operations team at Kaiser Foundation / Health Plan (KF /HP) is responsible for retrieving medical records for patients post visit and evaluating risk adjustment coded data to accurately capture the risk profile of members and ensure appropriate care delivery. As the VP of Chart Operations, you will report to the SVP of Risk Adjustment.  You will lead a large team and coordinate across internal and external stakeholders, including analytics, provider groups, markets, vendors and health plan stakeholders. You will be responsible for oversight of all functions within the Chart Operations team, including chart retrievals, coding and validation, and vendor management and reporting. A key capability for this role is includes fostering robust communication channels and collaborative relationships across the organization and the network to maintain organizational alignment and regulatory compliance. 

• Program Management:
  
  
  
  • Lead the development and implementation of programs and initiatives to drive post-care chart reviews, streamline vendor management, and improve coding accuracy
  
  
  
  


• Encounter Submissions and Audits:
  
  
  
  • Lead teams in management for Center for Medicare and Medicaid Services (CMS) encounter submission and auditing processes
  
  
  
  


• Vendor Collaboration and Management:
  
  
  
  • Foster robust collaboration and feedback loop with vendors and providers to ensure alignment with organizational goals and regulatory requirements and develop long term vendor strategy across all KF / HP markets.
  
  
  • Encourage relationships and feedback loops between internal overread teams and vendor to report feedback and trends on vendor completed chart reviews
  
  
  
  


• Data and Reporting Transparency:
  
  
  
  • Ensure data access and availability across all risk adjustment teams and stakeholders such as regulatory bodies and providers. 
  
  
  • Socialize reporting on performance and compliance metrics across the organization to ensure stakeholder awareness of trends and opportunities for program improvement.
  
  
  
  


• Data Submission Support:
  
  
  
  • Develop and implement initiatives to continuously improve data submission processes.
  
  
  • Specifically, helping teams identify areas to streamline processes and reduce submission turnaround times.
  
  
  
  


• Long Term Program Strategy:
  
  
  
  • Develop and implement innovative Chart Operations strategies that align with organizational goals and regulatory requirements.
  
  
  
  


• People Management:
  
  
  
  • Oversee a team of 70 FTEs and demonstrate ability to manage multiple team priorities and capabilities simultaneously
  
  
  
  


• Program Improvement:
  
  
  
  • Foster a culture of continuous improvement, encouraging team members to contribute ideas and solutions for enhancing operational processes.
  
  
  
  


• Regulatory Tracking:
  
  
  
  • Monitor CMS and market-specific requirements to ensure program compliance with regulations.
  
  
  
  


• Risk Management and Timeline Oversight:
  
  
  
  • Identify and mitigate risks within the team and with the vendor in a timely manner and ensure team is meeting timeline expectations for submissions
  
  
  
  


• Stakeholder Relationships:
  
  
  
  • Engage and maintain relationships with provider network, CMS and other regulatory stakeholders for accurate and seamless encounter submission processes
  
  
  
  


• Risk Management and Timeline Oversight:
  
  
  
  • Identify and mitigate risks within the team and with the vendor in a timely manner and ensure team is meeting timeline expectations for submissions
  
  
  
  


• Program Improvement:
  
  
  
  • Foster a culture of continuous improvement, encouraging team members to contribute ideas and solutions for improving operational processes through data driven findings.