Insurance And Risk Management Coordinator

The Insurance and Risk Management Coordinator will work closely with the Director of Quality and Risk Management, and the Fiscal team to assess evaluate and mitigate organizational risks. Their duties include communicating with leadership, staff, patients, insurers and legal partners. This will include investigating and follow-up with risk events. They will assist in the development and implementation of the best practice policies and procedures to minimize the impact of potential risks. The Insurance and Risk Management Coordinator will complete and submit all insurance applications / renewals. The Coordinator will make recommendations on changes to coverage with potential impacts to organization. assist in the development and implementation of best practice policies and procedures to minimize the impact of potential risks.

Education/Training:

• Bachelor Degree in Nursing/Healthcare Management, and or JD, Master's Degree preferred.
• HS Diploma required.

Licenses/Certification:

• CHPRM preferred

Required Qualifications and Skills:

• Positive interpersonal communication skills (both oral and written).
• Strong customer service skills.
• Must be extremely well organized and possess the ability to prioritize multiple tasks.
• Must be detail oriented and have efficient/effective work habits.
• Must be able to work independently, and be proficient in use of Microsoft Word, Excel, and related software.
• Previous Healthcare Risk experience, 3-5 years.

Preferred Qualifications and Skills:

• Initiative, ingenuity, strong analytical, organizational and interpersonal and problem solving skills.

Essential Job Functions:

• Complete and submit all insurance applications / renewals, make recommendations on changes to coverage with potential impacts to organization.
• Serve as point of contact for potential claims.
• Investigate potential claims, collect information, make recommendations on when to file claims (relative to deductible and impact on future premiums) and file claims as appropriate.
• Review potential claims and liability incidences to identify and mitigate risk to the organization.
• Provide recommendations and solutions to immediate problems.
• Collaborate with insurance and legal partners regarding potential and existing claims.
• Serves as a liaison to employees and providers involved in potential legal claims with guidance and support throughout the process.
• Provide follow-up documentation, meetings as requested for potential legal claims to insurance/legal partners.
• Collaborate with providers and staff regarding needed follow-up/information with claims.
• Participate in risk management activities, reviews e.g. Root Cause Analysis.
• Provide policy guidance, updates as necessary as related to risk, and risk strategy mitigation.
• Participate in risk assessment activities and development of action plans to bridge gaps as identified.
• Collect data, monitor trends and report results as directed to oversight committees.
• Utilizes the organization wide event reporting (feedback) system to manage, trend and track patient complaints, with proactive use of the CARE program for a proactive resolution.
• Provides risk management education regarding risk mitigation and other related education.
• Internal and external point of contact for Certificate of Insurance request; update internal systems as needed
• Ensure insurance invoices are properly accounted for within the various Sturdy organizations and ensure payment in a timely manner
• Completed all Insurance Audits
• Review contract language for compliance with insurance obligations
• Responsible for general and secondary tasks as needed or assigned.

Other duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

AGE AND DIVERSITY RELATED CRITERIA: Consistently treats patients, colleagues and visitors with the dignity and respect, while being sensitive to the differing needs of all age groups, backgrounds, characteristics and cultures.

ABILITY TO FULFILL JOB EXPECTATIONS: Must have the ability to the perform essential functions of the position, including required work hours, locations and physical demands, without posing a direct threat to the health and safety of themselves or other individuals in the work place, and with or without reasonable accommodation.

PHYSICAL DEMANDS: Sit for long periods of time. Repeat the same movements. Use hands to handle, control, or feel objects, tools, or controls. See details of objects that are less than a few feet away. Speak clearly so listeners can understand. Understand the speech of another person. Use fingers to grasp, move, or assemble very small objects

Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.