Risk Management Assistant bei Vcuhealth
Vcuhealth · Richmond, Vereinigte Staaten Von Amerika · Onsite
- Professional
- Optionales Büro in Richmond
Essential Job Statements
Clerical Staffing Coordination
Develops office guidelines and processes, monitoring and revising processes as needed. Maintain staffing and on-call calendar within the department. Triage and assign incoming calls and emails.
Operations Support for the Department
Coordinate and support risk management initiatives across departments.
Assist with risk assessments and developing mitigation strategies.
Monitor compliance with risk management policies and procedures.
Maintain records of incidents, insurance investigations and claims, and risk reports.
Assist in preparing risk analysis reports for leadership.
Support training programs related to risk awareness and compliance.
Collaborate with legal, Security, and operations teams to review processes and identify potential liabilities.
Stay updated on relevant laws, regulations, and best practices in risk management.
Lead the process of managing investigations and submission of assigned insurance claims.
Participate in audits and safety improvements.
Claim Investigations
Coordinate and manage belonging and fall claims investigations, including assignment of cases to internal or external staff or investigators.
Review claims for accuracy and completeness.
Interview staff and analyze medical records and provider documentation to validate claims.
Collaborate with providers, patients, legal teams, and regulatory agencies during investigations.
Prepare detailed investigative reports and submit summaries for claims resolution and review.
Ensure compliance with HIPAA, CMS, and other healthcare regulations.
Maintain accurate documentation and case files in claims management systems.
Monitor trends in claim discrepancies and recommend process improvements.
Educate and support staff on investigative procedures and compliance standards.
Assist in audits and regulatory reviews as needed.
Administrative Support
Completes and processes all certified and regular mailings. Processes recall notices and sends to appropriate departments. Maintains department SharePoint site including updating posted documents. Creates and edits documents, forms, and presentations.
Miscellaneous Responsibilities
Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the department. Assists team members. Accepts alternate assignments, as required, graciously. Provides education to units/departments when requested.
Patient Population: N/A
Employment Qualifications
Required Education: Bachelor's degree in healthcare administration, Business, Project Management, or related field from an accredited program
Preferred Education: N/A
Licensing/ Certification
Licensure/Certification Required: N/A
Licensure/Certification Preferred: N/A
Minimum Qualifications
Years and Type of Required Experience: Minimum of two (2) years of previous administrative work experience in an office setting. Previous experience with or knowledge of insurance or medical claim investigation and submission. Previous experience with Microsoft Office applications (Excel, Outlook, PowerPoint, etc.) and Adobe Pro
Other Knowledge, Skills and Abilities Required: Previous experience in customer service. Ability to manage multiple investigations and projects and meet deadlines in a fast-paced environment.
Other Knowledge, Skills and Abilities Preferred: Pr evious ex perience in a health care setting. Strong written and oral communication skills. De-escalation skills/experience. Strong analytical and critical thinking abilities. Ability to regularly exercise discretion, independent judgement, and decision making. Ability to work independently and within a team environment. Strong interpersonal, time management, and organizational skills. Project management and communication with a variety of individuals/entities.
Combination of education and experience in lieu of a degree.
Working Conditions: Periods of high stress and fluctuating workloads may occur. General office environment. May be exposed to verbal abuse. May be exposed to high noise levels and bright lights. May be exposed to limited hazardous substances or body fluids. * May be exposed to human blood and other potentially infectious materials. * May have periods of constant interruptions.
* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
Physical Requirements
Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Crawling, Climbing, Balance, Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards
Physical Requirements: Hear alarms/telephone/tape recorder
Hazards: N/A
Mental/Sensory – Emotional
Mental/Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking
Emotional: Fast pace environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
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