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Description
Overview:Under general direction, this position supports and manages the insurance program for OBHS, and is responsible for assisting in all insurance procurement tasks. Evaluates accident reports to determine accuracy and completeness and to ensure adequate investigation. Responsible for claims monitoring and administration, report generation, and communication with employees, managers, insurance carriers, medical staff, and lawyers. Requires the handling of any and all sensitive business, employee and medical information in a confidential and appropriate manner. Assists with Patient Relations functions as deemed necessary.Responsibilities:Evaluates accident reports, reviews medical reports, witness statements, department investigation results, and other documentation as related to claims management.Maintains subrogation records and files for those incidents involving third parties. Sends subrogation letters to third parties in an effort to obtain reimbursement of monies spent for medical treatment, time loss, and awards and settlements paid, and to submit to involved third parties.Compiles facts and data regarding accident reports and filed cases.Advises and/or assists departments in conducting investigation of accident reports, including interviewing of witnesses and procurement of relevant documentation.Reviews accident reports to identify patterns of injury and to determine whether unsafe conditions contributed to the accident; advises Director Risk Management of trends in injuries and proper safety procedures that may result in reduction of injuries; provides department with information that will aid in reducing accidents and improve safety.Maintain loss histories, and provide loss runs via computer interfacing with carrier.Maintain and update the Schedule of Insurance, reviewing for expiring policies to ensure renewals can be secured and bound timely, and assist with all aspects of maintaining active, current insurance.Maintains insurance files for all lines of insurance, access to the current policies.Takes the lead on securing loss runs and exposure data, and interacting with the brokers to begin negotiations of upcoming insurance renewals.Participate in site inspections and follow up to ensure carrier recommended changes are being carried out by hospital administration.Coordinate the handling of vendor accidents/incidents, obtaining incident/accident report from the project manager and construction manager, and maintaining a file regarding these occurrences.Secure evidence of insurance as needed and distribute accordingly.Assists in preparation of department annual budget.Assists in letter of credit negotiations.Assists with monitoring systems necessary for identification, evaluation, reduction and elimination of professional and general liability risk exposure.On-boarding and Off-boarding of Medical Staff.Works collaboratively with the Finance Department to ensure all insurance payments are made timely to secure our credit relationship with all lenders.Assists in developing and implementing policy and procedures to minimize the risk of injury to patients, visitors and employees.Adheres to the highest standards of confidentiality and is well versed in the legal requirements of The Health Insurance Portability and Accountability Act of 1996 (HIPAA); The Americans with Disabilities Act of 1990 (ADA) requires employee medical and disability information be kept confidential and limits access to those employees who have a business need-to-know and employee information including, but not limited to personal identifying information (e.g., an employees Social Security number, home address or telephone number, salary, etc.)Every 90 days, initiates a status or a follow up on all open claims.Attend claims reviews at either client or carriers locationCoordinates activities that focus on the management of litigation claims and pretrial preparation.Provides direction and coordinates counsel to physician, nursing and administrative staff regarding medical-legal issues.Assists in investigating actual and potential adverse outcomes/sentinel events, report pertinent events to State Department of Health (SDOH) via New York Patient Occurrence Reporting and Tracking System (NYPORTS), assists in completion of root cause analysis, case write-ups and in implementing corrective measures. Assists gathering information for notification and tracking of SDOH through NYPORTS system.Assists in notification to insurers of non-asserted and asserted litigation matters.Investigates events that led to real or potential patient harm. Assists Patient Relations with the resolution of complaints when warranted. Assists in analyzing weekly HCAPHS reports and subsequent corrective actions and improvement plans. Provides support and incident response when there are concerns involving the quality of care rendered to a patient or general patient safety concerns.Assists in the preparation of Quality Council quarterly presentations.Performs Risk Management and Insurance related work as required.Qualifications:Experience:A minimum of 2 years of working knowledge of claims management.A minimum of 1 year health care supervisory experience.Education:Bachelor’s Degree.Master’s Degree preferred.Knowledge and Skills:Working knowledge of medical terminology, body systems, and/or impairments and their disabling effects.Good judgment in interpreting medical facts presented by a physician and applying these facts in determining an individual’s capacity to engage in gainful occupation.Strong mathematical and analytical ability.Excellent computer skills.Proficiency with Microsoft Office to include Excel, Word, and Outlook.Good interpersonal skills a must.Ability to communicate effectively in English, both verbally and in writing.Good written and verbal communication skills.Ability to effectively interact with employees, managers, vendors, attorneys, carriers, etc. Physical Requirements:Involves standing, walking, and talking.Frequent sitting for extended periods of time.May include some repetitive motions. Perform other duties as required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions without compromising patient care.The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of One Brooklyn Health System (OBHS), and Interfaith Medical Center (IMC).One Brooklyn Health System (OBHS), and Interfaith Medical Center are an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.
Posted on :
2021-09-01T08:43:54Z
