This position will work with Clinical Integrity leadership on the performance of audits and reviews and provide advanced support to OHSU related to federal and state requirements governing clinical documentation, coding, and the revenue cycle. Reviewing medical record documentation to evaluate coding, researching and understanding the billing requirements, and monitoring the appeals process for denied claims are key aspects of the Clinical Integrity team and this position.
The Clinical Integrity Specialist 2 works under the direction of the Clinical Enterprise Integrity Officer and other senior professionals within Integrity. This position is an advanced professional resource providing specialized and detailed guidance, and performs reviews as assigned related to all aspects of clinical billing activities to determine conformity with federal and state regulations and OHSU policies. Specifically, the Clinical Integrity Specialist 2 is responsible for the planning, execution, and reporting of all audits/reviews, advisory services and investigations in accordance with departmental standards and procedures.
The Clinical Integrity Specialist 2 will:
Demonstrate a solid understanding of auditing, analyzing, and advising on a variety of clinical billing issues
Demonstrate a solid understanding of risk evaluation and a risk-based approach in order to prioritize work and issue relevant and reasonable conclusions and findings
Ability to conduct a detailed review, including interviews, document review, and data analytics
Demonstrate the ability to reach and support conclusions based on knowledge of risk and controls and the ability to discuss and collaborate with management to facilitate an effective action plan