OhioHealth

Human Resources

• 80% Initiates and performs technical procedures to analyze, or reanalyze, and monitor for medical records deficiencies according to Joint Commission and Medical Staff Rules and Regulations for regulatory requirements.
• Assists in the execution of physician notification processes regarding medical record documentation deficiency, delinquency, and suspension, including deficiencies impacting the DNFB.
• Execute the task of closing and verifying the episode of care by ensuring that all pertinent clinical documentations are in the medical record.
• Perform the re-analysis and loose scanned document analysis separately from discharged medical records.
• Identifies providers with outstanding deficiencies, updates the providers’ statuses, and update the episode of care for the chart completion.
• Identify charts and analyze charts for concurrent analysis and assign deficiencies as required.
• Tracks and meets productivity, timeliness, and quality standards and goals set by the department.
• Communicates cooperatively and constructively with physicians, clinicians, and physician office staff.
• Maintains compliance with pertinent OhioHealth policies and procedures.
• 15% Manage the suspension process to ensure that all documents are complete and accurate in the episode of care to complete the chart.
• Assists in cross-training other employees as necessary.

EHR Deficiency Analyst

Manager

• The position requires a diverse set of organizational skills, medical chart review and analysis, knowledge of claims appeal process and ability to apply Interqual, Milliman practice management guidelines to determine medical necessity and appropriateness of coding and billing; Must have the ability to research complex issues pertaining to Medicare reimbursement and payment policies; This position assists in development, implementation, refinement and reporting of the RAC case management and appeals program; It is accountable for reviewing documentation of clinical care provided, financial outcomes of an assigned population, coordinating clinical documentation, drafting appeal letters and identified for RAC audits and appeals in response to a claims denial from the RAC; He/She works collaboratively with all interdisciplinary staff internal to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of the RAC case management appeals process

RAC Case Manager

Director

• Reports to VP of IT Solutions Delivery and is accountable for successful program and project delivery within the portfolio.
• The Corporate Portfolio includes Corporate Applications (HR, Finance, Supply Chain), Shared Services (Lab, Imaging, Pharmacy, etc.), and Revenue Cycle.
• This position works as a trusted partner in collaboration with multiple stakeholders within IS and across the enterprise with high transparency and reliability.
• 30% Results Management: Apply extensive knowledge and expertise of solutions, application design, solution development and deployment to solve complex business problems and achieve strategic initiatives.
• 30% Strategy: IT planning and oversight to OhioHealth’s growth and innovation strategies. Drives innovation throughout the organization by challenging existing norms, thinking differently, and understanding how technology can be leveraged. Maintains a high level of competency stays abreast of industry trends in software delivery ways of working in order to effectively develop enterprise strategies.
• 20% Supplier Management: Works with suppliers and vendors to produce outcomes consistent with organizational strategy. Oversees reporting metrics, dashboards and status reporting to meet expectations for quality.
• 10% People Management: Directs all human resource aspects of personnel management within assigned area including selection of new associates, initial and ongoing development, evaluation, etc.
• 10% Financial Management: Plans, monitors and controls operating and capital budget for assigned areas of responsibilities.
• Equal Employment Opportunity and company values.

Director, IT Solutions Delivery - Corporate Portfolio

• Improves quality, safety and reduces operational risk via performance improvement processes and regulatory compliance for OhioHealth's surgical services.
• Facilitates, influences, plans, consults, educates to incorporate continuous quality improvement across quality/risk functions.
• Leads projects with multidisciplinary teams; analyzes data for continuous improvement; teaches performance improvement tools; ensures regulatory compliance.
• Mentors staff; promotes a culture of continuous improvement; applies evidence-based practice in projects; aligns with organizational goals.

Clinical Outcomes Manager, Surgical Services, PSI/HAC Improvement

Network Operations

• Oversees NCQA accreditation by the National Committee for Quality Assurance and regulatory compliance; maintains oversight of NCQA credentialing policies; ensures compliance with regulatory guidelines.
• Serves as an administrator for the Network Operation Entity in the Credentialing software; field questions and evaluate permission requests for end users.
• Supports selection and implementation of credentialing software systems/enhancements; trains staff on new platforms.
• Oversee enrollment function for OH-Independent Medical Group or transferring from a TIN previously in the CIN; ensure enrollment with CIN and OhioHealth payers including Medicare/Medicaid prior to go-live.
• Coordinates CIN Membership Committee activities: CIN Medical Director Review, Provider Network Development Committee, Credentials Committee and Peer Review Committee; prepare and distribute credentialing docs, agendas/minutes.
• Provide regulatory guidance to CIN Medical Directors and follow-up on reviews.
• 40% Leadership: planning and decisions; servant leadership and collaboration with OhioHealth leadership, CVO, OH-Independent Medical Group administration, legal counsel, and other stakeholders; Population Health involvement; professional development; adaptability.
• 10% Additional Network Operations Support: optimize workflows, identify bottlenecks, implement streamlined processes, utilize data analytics to track KPIs, produce reports (e.g., Qlik, turnaround time, CI Monitoring, Eligibility).

Network Operations Manager

Analyst

• Supports the System-wide Enterprise Master Patient Index (EMPI), chart corrections, duplicate merges, overlays for all OhioHealth entities on Epic (Care Connect).
• May support EMPI functions related to Community Connect entities.
• Analyzes regulatory requirements including Joint Commission, the 21st Century Cures Act and HIPAA.
• Evaluates in baskets and interface error queues requiring deductive reasoning to ensure accurate documentation in the patient’s EHR.
• Performs data abstraction and uses computer skills to aid in data integrity and customer service.
• Communicates with downstream systems/departments and external facilities regarding MRN changes and HIE operations.

EHR Deficiency Analyst

RAC Case Manager

Director, IT Solutions Delivery - Corporate Portfolio

Clinical Outcomes Manager, Surgical Services, PSI/HAC Improvement

Network Operations Manager

Data Integrity Analyst, Revenue Cycle