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Form of work***Available for Hybrid Work***
The Chief of Clinical Integrity (CIO), OHSU Health serves as the focal point for all clinical compliance activities, reporting to the Executive Vice President and Chief Executive Officer with a direct reporting relationship to the UHS Board of Directors. The CIO, OHSU Health coordinates and communicates all assigned compliance activities and programs, as well as plans, implements, and monitors the Clinical Compliance Program. The CIO, OHSU Health ensures that the OHSU Health System meets federal and state laws, regulations, and guidance relating to clinical billing compliance. This position is responsible for the development, coordination, implementation, maintenance, and oversight of an integrated Clinical Enterprise Integrity program that comprises both professional and facility billing and coding practices and compliance requirements. The Clinical Integrity function will support and foster a culture that encourages compliance with legal and regulatory billing and reimbursement requirements and practices, which will be accomplished through education, monitoring, and consulting services utilizing a risk-based approach for potential areas of non-compliance.
In fulfilling the responsibilities of this position, the CIO, OHSU Health will collaborate with a broad spectrum of organizational partners, such as Regulatory Compliance, Legal, Clinical Enterprise providers, Enterprise Revenue Cycle, Hospital Administration; Faculty Practice Plan and School of Medicine leadership, directors and managers, OHSU School of Nursing, OHSU School of Dentistry, Human Resources, various committees and various integrity programs throughout OHSU - including the Central Integrity Office and the OHSU Chief Integrity Officer. This position facilitates clinical integrity within the scope of the position's responsibility at OHSU by providing leadership and collaborating with the Clinical Enterprise and other organizational partners to:
- Implement, revise, and maintain applicable policies and procedures (program-specific and OHSU-wide) to maximize integrity, compliance, effectiveness, efficiency, and reflect current trends;
- Develop, implement, and maintain training and communication programs for the OHSU community. Education should be focused on general and specific compliance requirements, known regulatory compliance issues or changes, and the operational activities of OHSU clinical services, including documentation, coding, and billing requirements necessary for compliant billing practices;
- Serve as an expert resource for Clinical Enterprise by working closely with clinical and organizational leadership, and coordinating with other organizational safeguard departments (e.g. Regulatory Compliance, Legal , Risk Management, Enterprise Revenue Cycle, Quality, Human Resources, Central Integrity, etc.) to identify and address issues that affect the organization, its regulatory environment and compliance responsibilities;
- Develop continuous process improvement initiatives related to Clinical Enterprise integrity;
- Serve as a management representative on assignments for both internal and external constituencies.
Department leadership and management: Using knowledge of federal, state, local, and
institutional regulations, guidance, and policies and procedures:
- Hire, train, manage, and evaluate Clinical Enterprise Integrity team.
- Direct team activities to ensure department objectives are met. Develop and implement an annual, risk-based work plan related to Clinical Enterprise integrity (as assigned) and the identification of appropriate mitigation of risks, working collaboratively with organizational partners throughout the process.
- Establish and maintain adequate documentation retention practices for work product.
- Perform quality control reviews of work performed.
- Work with team to ensure appropriate and timely close-out of issues and reviews.
- Collaborate with leadership of areas being reviewed; provide recommendations and define management action plans; follow-up on the status of recommendations and determine whether appropriate corrective action has been taken.
- Manage departmental budget.
- Serve on various institutional committees related to Clinical Enterprise integrity.
Policies and procedures: Ensure that requirements (e.g., local, state, and federal regulations and guidance as well as related OHSU policies and procedures) are appropriately described in OHSU policies and procedures.
- Develop and participate in development of policies and procedures with organizational partners and applicable committees, as needed.
- Identify deficiencies and advise on how to achieve compliance with regulatory requirements in an effective, efficient manner.
- Conduct ongoing review of policies and procedures, collaborating with departments to ensure correction and re-education, as necessary.
Training, communication, and advisory services: Identify, develop, and implement training and communication outreach to the OHSU community regarding Clinical Enterprise Integrity.
- Serve as an expert resource for Clinical Enterprise integrity issues to the OHSU community and provide information and responses to inquiries related to regulatory, strategic and operational issues, concerns, and questions.
- Communicate effectively and appropriately to all levels of the organization.
- Facilitate and lead the Clinical Integrity Compliance Committee.
- Provide effective and timely reporting on Clinical Enterprise Integrity activities to senior leadership, various compliance/integrity committees, and the UHS Board of Directors and its subcommittees.
Continuous Quality Improvement: Develop and implement a program of continuous quality improvement for the Clinical Enterprise Integrity team/department.
- Identify weaknesses and deficiencies, and implement solutions to enhance departmental effectiveness to improve support to the OHSU community.
- Develop and monitor program metrics to improve program effectiveness.
- Establish an ethical, Clinical Enterprise integrity audit ready and efficient OHSU.
Other duties as assigned: Including investigations and other special projects.
Required QualificationsEducation:
- Bachelor's degree in Business Administration, Healthcare Administration, or related. In lieu of degree, equivalent education and/or experience may be considered.
- Certified in Healthcare Compliance (CHC)
Experience:
- Three years management experience with direct management responsibility for Clinical Compliance.
- Five years recent experience in Clinical Compliance or related function. OR
- Any combination of experience that would provide the required equivalent qualifications.
Job Related Knowledge, Skills and Abilities:
- Exceptional people and ethical skills. Ability to interact in a positive, productive manner with providers, administrators and leadership (demonstrating sensitivity, tact, and professionalism) and employees.
- Extensive knowledge of best practices for clinical compliance at an academic medical center and/or large multi-disciplinary system and understanding of risk assessment methodologies and systems thinking.
- Expert knowledge in federal and state laws, regulations, and guidance relating to clinical billing compliance.
- Ability to analyze information and construct an action plan to resolve issues.
- Ability to collaborate effectively and work both independently and in a team environment.
- Effective organizational abilities, oral and written communication skills, and interpersonal skills.
- Ability to operate and communicate effectively while meeting multiple deadlines and completing projects simultaneously
- Advanced proficiency with electronic systems and software.
- EHR experience in an academic medical center
- Ability to work in a fast paced and changing environment; reacts professionally under pressure.
- Strong facilitation and mentoring skills.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities across multiple teams/projects, platforms.
- Excellent time management skills.
Education:
- Advanced degree or additional emphasis/training/education in related field
Experience:
- Seven years of management experience in an academic medical center or large multi-disciplinary system with at least four years of experience in facility and professional fee documentation, coding and billing.
- Certified in coding: CPC (AAPC) or CCS-P (AHIMA)
Job Related Knowledge, Skills and Abilities:
- Application of risk-based decision making in furtherance of organizational efficiency and compliance.
- Demonstrated leadership and formal/informal influence skills
- This position is a hybrid position and may require frequent visits to campus. Travel to and participate/attend community outreach events and training.
- Ability to handle multiple highly sensitive projects and priorities simultaneously.
- Occupant may represent the University on a frequent basis.
