Provides day to day operational support for Risk Management. Responsible for identifying, assessing, and reporting areas of risk in an effective manner. Organizes and implements policies and procedures necessary to support risk structures and processes. Updates processes to reflect regulatory changes.
This position serves as a point of contact for staff for event reporting system questions and concerns, both new and ongoing. Supports the Risk Management program by working reported risk events: reviewing problems, addressing gaps in process, recommending solutions, enhancing quality care, requesting steps to mitigate risk, promoting prevention plans and monitoring the event to resolution.
The position is responsible for identifying internal health system quality and risk issues and assisting the risk manager with analyzing the root causes and underlying factors. This Coordinator will work with other Managers, Supervisors and medical staff leadership to develop process improvements to enhance care quality, reduce risk, and minimize litigation claims. The risk coordinator will develop and implement risk management educational programs.
ESSENTIAL JOB FUNCTIONS:
Performs routine audits of and monitors risk functions. Recommends mitigation factors and modifications in collaboration with the Risk Manager.
Develops and implements risk prevention policies and procedures in collaboration with the Risk Manager with input from relevant committees.
Receives, develops and communicates appropriate responses to medical care complaints in collaboration with the Risk Manager.
Performs improvement activities related to issues that are connected to peer review, root cause analysis, and other patient safety concerns.
Develops and implements risk education for IHA. Educates staff on correct principles, procedures and standards as necessary.
Supports legal case processes with STARS entries and medical record requests. Monitors legal case files; ensures all active risk management cases are properly logged; tracked and records secured; responds to legal questions and depositions.
Participates in an enterprise wide risk assessment for IHA on an annual basis, in collaboration with Compliance team.
Provides input into a comprehensive risk work plan and long-term strategy in order to effectively manage and mitigate any identified compliance risk factors.
Assists with maintenance of an electronic information database for investigative activity; Utilizes data from trend analysis for the identification of opportunities to strengthen internal processes and minimize risk areas.
Responsible for completion of annual Trinity Health risk renewal application; for review by the Director of Compliance and Risk and COO.
Attends Clinical Policy Task Force as a department representative, as requested. Attends and participates in committee meetings as necessary.
Maintains patient and employee confidentiality in compliance with IHA guidelines.
Maintains knowledge of office services and workflows.
Maintains complete knowledge in the use of all relevant office equipment, computer, and manual systems.
Assists with other duties and special projects as assigned.
EDUCATION: Bachelor's Degree or equivalent combination of education and experience.
CREDENTIALS/LICENSURE: Certified Medical Assistant, Licensed Practical Nurse or Registered Nurse, licensed by the State of Michigan with relevant clinical experience required.
MINIMUM EXPERIENCE: Three or more years' experience working with clinical operations, compliance, HIPAA, healthcare risk management, regulatory standards, patient safety and other relevant areas. Background as a preceptor or some type of education in role is desirable. Care Management experience a plus.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
Knowledge of federal, state, and insurance company regulations and contract requirements affecting compliance in a healthcare setting; understands managed care and insurance practices.
High level of attention to detail.
Interest or knowledge of process improvement.
Well-developed understanding and/or hands on experience with office processes, procedures and workflows.
Maintains working knowledge on insurance billing and coding requirements, rules and regulations for government and private payers.
High level of proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, Database software, Microsoft Word and Excel, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job including EPM and EHR systems.
Proficiency in planning, organizing and prioritizing workloads.
Ability to develop and maintain effective professional working relationships with all levels within IHA as well as outside contacts.
Effective, professional communication skills, verbal, written and during group presentations.
Ability to coordinate activities and work independently to complete projects requiring highly complex analysis.
Works collaboratively in a team-oriented environment; courteous, professional and friendly demeanor.
High level of organizational and time management skills with ability to effectively juggle multiple priorities and time constraints in a fast-paced environment.
Exercise sound judgment and problem-solving skills.
Ability to analyze complex data to monitor IHA's compliance with our standards and billing practices, and procedures.
Ability to maintain any organizational, patient and employee information in a confidential manner.
Successful completion of IHA competency-based program within introductory and training period.
Ability to travel to other office/practice sites and meeting and training locations.
Ability to work overtime hours as scheduled.
Internal Number: 000002
Headquartered in Ann Arbor, Michigan, IHA is one of the best and largest multi-specialty groups in Michigan delivering more than one million patient visits each year. IHA employs more than 2,200 staff, including more than 650 providers consisting of physicians, nurse practitioners, physician assistants and midwives in approximately 70 practice locations across Southeast Michigan. Recognized as Metro Detroit’s Top Physician Group by Consumer Reports magazine, IHA also ranks in the top quartile for patient, staff and provider satisfaction nationally. IHA offers patients extended office hours and urgent care services, along with online patient diagnosis, treatment and appointment access tools. IHA is a wholly-owned subsidiary of Saint Joseph Mercy Health System and a member of Trinity Health.
Here are a few facts about IHA to help you understand our impact on the communities we serve in Washtenaw, Livingston, Lenawee, and western Wayne Counties:
Office Locations: More than 70
Active Patients: More than 485,000 patients
Babies Delivered: 3,583 last year (2017)
Nurse Practitioners/PA-C's/Certified Nurse Midwives: 138
Board Certified/Eligible Ph...ysicians: 100%
Hospital Affiliations: St. Joseph Mercy Ann Arbor, St. Joseph Mercy Chelsea, St. Joseph Mercy Livingston, St. Mary Mercy Livonia, Michigan Medicine
Support Staff: Over 1,600