Healthcare Risk Advisors has an exciting Clinical Risk Management Coder position available in their NYC office!
Candidates must have a clinical nursing background. The positionfunctions as a coder to code malpractice cases.
The Senior Risk Analyst is responsible for the review and analysis of medical malpractice claims from a clinical perspective, including the identification of contributing factors related to an event/claim, data classification and clinical narrative preparation. The SRA applies critical thinking and sound judgment in applying coding taxonomy consistently across multiple fact patterns. Works closely with CRICO’s Coding Manager to ensure inter-rater reliability within CRICO’s Comparative Benchmark System.
- Reviews claim files and medical records to discern, identify and code claims with all pertinent data using CRICO clinical coding taxonomy in combination with ICD-9 and 10 classifications.
- Reviews pleadings, expert reviews and relevant legal correspondence to discern issues in litigation and drivers related to agent of loss.
- Creates a comprehensive clinical narrative of the care provided in each case reviewed.
- Identifies the contributing factors related to the claim and care rendered.
- Participates in periodic skill development and education sessions, including best-practice reviews, with CRICO management and bi-weekly coding conference calls.
- Conduct various CRICO coding projects and provide support to other risk Management Department projects as assigned.
- Conducts preliminary coding (cursory review) within two days of receipt of cases. This involves the coding of three categories; allegations (if applicable), injury/severity, primary responsible service and confirm responsible service.
- Conducts full coding (extensive review) a minimum of 50 cases per month. This involves the coding of 14 categories including review of medical records, pleadings, defense counsel analysis/interviews, expert reviews, ICD-9 and 10 codes, etc.
- Conducts final coding of closed cases within established deadlines.
QUALIFICATIONS AND REQUIREMENTS:
Education and Experience Required
- RN, PA or MPH. Bachelor’s degree preferred.
- 2-5 years’ experience in hospital critical care and/or risk management including exposure to medical malpractice litigation in NY and the types of pleadings utilized.
- Experience in conducting root cause analyses and/or healthcare related investigations helpful.
- Preferred background includes experience in investigating malpractice claims or adverse events.
- Strong clinical background in healthcare, including demonstrated knowledge of medical terminology.
- Broad knowledge of healthcare organizations/providers, clinical risk management, safety, regulatory requirements, and health care quality and accreditation functions.
- Strong analytical skills with demonstrated ability to conduct systematic and methodical analyses. Ability to read claim files and medical records and synthesize the essence of the event.
- Attention to detail, thoroughness and demonstrated ability to consistently deliver accurate work products.
- Excellent organizational skills, with demonstrated ability to independently set systems in place to track projects and work, and to consistently follow through on task completion.
- Ability to manage multiple priorities, prioritize work according to urgency and importance, and consistently meet deadlines in a fast-paced work environment.
- Ability to work with minimal guidance or direct supervision and make independent decisions.
- Ability to maintain confidentiality of highly important and sensitive information.
- Proactive; identifies work to be done and does it; looks forward to plan upcoming needs and work.
- Strong interpersonal and communication (both verbal and written) skills.
- Proficient in Microsoft Office products including Word, Outlook, PowerPoint and Excel.
- Ability to travel to CRICO’s annual Collaborative, generally held in the greater Boston area.
Healthcare Risk Advisors, Inc., formerly Hospitals Insurance Company, provides comprehensive insurance and risk management advisory services to leading academic hospitals, long-term care facilities, and social services agencies in the metropolitan New York area.
Healthcare Risk Advisors employs a best-in-class approach to risk management that includes risk transfer, development of favorable insuring terms, and dedicated client services throughout the entire claims process. Our team includes accomplished insurance and brokerage professionals as well as attorneys with extensive experience in claims litigation, insurance, and contract law.
HRA’s goal is to ensure that our clients have appropriate levels of coverage—as well as access to risk prevention services and resources—so they can focus their time and effort on the communities they serve.
HRA offers countless career opportunities and an environment which fosters professional advancement and success. Visit www.healthcareriskadvisors.com to learn more about our company.
HRA is an equal opportunity employer.