Required Education and Experience:Experienced Medical Assistant (Certified or Registered) or LPN required. Healthcare risk management, prior claims, or general or professional liability experience a plus. Department operations/administrative responsibilities preferred.
Additional Eligibility Qualifications:Requires excellent interpersonal, problem solving, and communication ability. Must manage multiple tasks and meet deadlines while maintaining flexibility for changing priorities. Proficiency in Microsoft Word and Excel required. Database management skills and an understanding of departmental reporting requirements necessary. Must understand basic quality improvement/risk management processes and demonstrate commitment to departmental and organizational goals. Experience with electronic medical record systems a plus.
ESSENTIAL FUNCTIONS- Patient Safety
Works with departmental Patient Safety Assistant to record and review patient, employee, and visitor injuries in the facility, parking areas, Blue Team and Code 99�s. Ensure injury events are submitted as General Liability claims and/or that billing and reimbursement is managed appropriately.
Ensures timely and complete documentation of data into RESPOND databases.Generates routine and ad hoc reports including billing, claims, credentialing requests, etc.
ESSENTIAL FUNCTIONS- Claims and Liability
Partners with the Claims/Liability and Deposition Specialist to cover the following responsibilities:
Facilitate/coordinate professional liability activities for new claims and pending cases, as well as FDOH investigations. Tracks, records, and ensures integrity and accuracy of legal billings, payments and collections.
Produces all records, reports, and policies as requested by attorney and RM Director as needed on liability issues and claims. Creates a copy of Watson Clinic medical records for the RM Director to review at the onset of a new claim.
Assists attorney with scheduling provider depositions or other meetings for Watson Clinic related claims.
Notifies insurance broker within 15-30 days regarding new claims, precautionary events, mediations with resolution as well as any other important events that are scheduled or occur for each claim.
Discusses potential dismissal of patient and family members/claimants when a new NOI is received, with Director and Risk Management Physician. Discussion within 15-30 days of receipt of NOI with completion of dismissal within one week after discussion, as applicable.
Review all legal claims from a medical perspective. Reviews copy of chart requested with new NOI and assures complete chart has been sent to requesting parties.
Accepts subpoenas and reviews other attorney requests and correspondence.
ESSENTIAL FUNCTIONS- Medical Chart Review
Creates a copy of Watson Clinic medical records for the RM Director to review at the onset of a new claim; separating and printing as needed to review problematic areas of patient care with director and RM physician. Retrieve applicable policies relating to case.
Committee responsibilities: Attends professional liability PL meetings with RM Director, CFO, and FinanceDirector or other meetings at the request of the RM Director.
Take the lead on preparing documentation for submitting events as precautionary claims, notices to regulatory/licensing boards, etc. and ensuring appropriate and timely reporting to NPDB,State Board of Insurance, and Medicare (if applicable) at claim closure within regulatory required time frames.Works with attorney and RM Director to assure accuracy in report information before it is submitted.