This position works in the OHSU Clinical Enterprise Integrity program with duties that span the clinical enterprise at OHSU and partner hospitals. Clinical Enterprise Integrity oversees and manages programs and policies aimed at minimizing regulatory and billing risks to the OHSU healthcare mission. The Clinical Enterprise Integrity program encompasses all of the clinical billing activities at OHSU, as well as regulatory requirements over the operation of the clinical enterprise and the care of patients as related to the regulatory requirements of the federal and state healthcare programs.
Assist in the development, implementation, and maintenance of the compliance program for Healthcare Hospital and Professional Services. Develop and write policies and procedures that set up standards for compliance, giving specific guidance to management and individual departments.
Assist in developing and implementing a compliance education and training plan for licensed independent practitioners, including lesson content, methods of delivery, and time lines.
Assist newly-credentialed/privileged physicians, non-physician practitioners with assessing clinical activities and determining billable services. Evaluate the medical necessity of encounters, and level of care. Periodically review clinical services performed to ensure compliance with laws, rules and regulations, including reviewing medical records for compliance with documentation, coding, and billing requirements.
Act as a resource to clinical areas on compliance issues. This may include researching laws, rules and regulations; seeking legal advice; meeting with appropriate individuals; developing action plans and time lines, and assisting with implementation. Work with Human Resources to ensure that compliance policies and procedures are enforced through appropriate and consistent disciplinary action.
Monitor regulatory developments and OHSU operational changes; keep current on rules, regulations, and advances in the field of compliance; clarify government rules with appropriate parties and entities. Educate and communicate to stakeholders government regulations and their impact on Healthcare System practices.
Conduct reviews and audits of clinical risk areas particularly as identified by the HHS Office of the Inspector General using self-assessment questionnaires, verification procedures, and internal audits. Draft reports and recommendations of reviews and audits. Work with internal auditors and OHSU Legal department as necessary.
Respond to external audits and government investigations, including reviewing documents, developing an action plan, coordinating work assignments, tracking time lines, and working with internal and outside legal counsel
Assist in identifying and assessing areas of compliance risk based on the OIGs Annual Plans, awareness of Healthcare operations, new laws, rules, requirements, and government audits.
Independently investigate and act on matters related to compliance. Supervise project work, including less experienced staff assisting in the projects. Respond to requests/concerns from compliance hotline, compliance email or OHSU employees, as well as determine need for investigations.
Bachelor's degree or equivalent experience
Five years experience with clinical documentation, billing and coding
Familiarity with a high complex administrative and financial environment.
Strong interpersonal skills and evidence of previous success in dealing with staff (at all levels) including nurses, non-physician practitioners, physicians, and management
Knowledge of inpatient and outpatient professional documentation, coding, billing requirements in an academic health center or a large outpatient component.
Excellent interpersonal, writing and public speaking skills.
Ability to work independently, take initiative, exercise sound judgment, and meet deadlines
Maintain confidentiality where appropriate; able to participate in extremely sensitive situations.
High degree of accountability, honesty and integrity.
Must be able to perform the essential functions of the position with or without accommodation
Master's degree in Healthcare Administration, nursing, or related field
Management experience in an academic health care setting or large physician group practice.
Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or firstname.lastname@example.org.
As the state's only health and research university, OHSU brings together patient care, research, education of the next generation of health care providers and scientists and community service to improve the health and well-being of all Oregonians.The university is a conduit for learning for more than 2,800 students, providing training to interns, residents and fellows in postgraduate medical and research. It is the only place in Oregon that grants doctoral degrees in medicine, dentistry and nursing. OHSU cares for more than 251,000 patients each year from around the region and takes a leadership role in contributing to solutions involving the health of the state and the nation, such as health care access and transparency, ethics and workforce shortage. Beyond providing critical health care services, quality education and cutting-edge research, OHSU also is a key economic and social force in the Northwest. With an annual operating budget of $2.06 billion and more than 14,000 employees, OHSU is Portland?s largest employer. Its size contributes to its ability to provide... many services and community support activities not found anywhere else in Oregon. For more information visit http://www.ohsu.edu/xd/about/index.cfm