Analyst-Claims

Job Category: Legal / Compliance Work Shift/Schedule: 8 Hr Morning - Afternoon Northeast Georgia Health System is rooted in a foundation of improving the health of our communities. About the Role: Job Summary Responsible for investigating patient safety/harm events that may lead to a medical malpractice claim. Works closely with patient care and ancillary departments in following up on adverse patient events. Supports litigation and legal team with acquiring necessary documents for responsiveness to medical malpractice lawsuits. Assists with clinical risk management opportunities in areas of assigned responsibilities. Works closely with Patient Safety team and initiatives. Documents accordingly in patient variance system. Demonstrates follow up with assigned claims and makes Risk Management leadership aware of potential liability claims. Supports standard work for patient events related to root cause analysis or investigations. Minimum Job Qualifications Licensure or other certifications: Registered Nurse. Educational Requirements: Bachelors in Nursing. Minimum Experience: Five(5) years of progressive clinical experience in an acute care setting. Other: Preferred Job Qualifications Preferred Licensure or other certifications: Preferred Educational Requirements: Preferred Experience: Other: Job Specific and Unique Knowledge, Skills and Abilities Interpersonal skills, excellent communication skills, leadership ability Business planning, writing skills, problem solving Knowledge of personal computers and automated data bases, implementation and support skills Ability to analyze the patient care process in a systematic fashion Essential Tasks and Responsibilities Assist the Director of Risk Management with the development and maintenance of a system for the proper reporting, follow-up investigation, analysis and filing of all liability claims that occur in the organization. Assumes investigation of assigned patient care adverse events having potential or actual liability exposure to the organization related to patients and visitors. Assumes collection of all information necessary for the defense and resolution of liability claims established through the organization and commercial insurance policies. Demonstrates ability to interview staff in a professional and non-intimidating manner related to patient harm events. Assists in the evaluation of correspondence from attorneys; patients and other outside sources and assists in formulating responses as necessary. Participates with reporting relationships for monitoring evaluation of the risk management program to the appropriate committee structures. Assures confidentiality/security of office files including maintaining verbal confidentiality related to patient and claims files. Maintains a documentation process for tracking development of liability claims. Maintains patient variance and claims files. Maintains appropriate documentation for reporting applicable events to the Department of Community Health. Provides necessary documentation as directed for participating in the Partnership for Health Accountability Program. Initiates paperwork as directed to comply with the Safe Medical Devices Act. Supports root cause analysis (RCA) related to patient harm events sentinel events to comply with claims management and accreditation agencies and patient safety initiatives. Assists the Director of Risk Management and organizational legal counsel with preparation for any litigation. Works with other members of the department to acquire necessary information for responding patient harm, medical malpractice claims and lawsuits. Coordinates medical record needs with Health Information Department. Coordinates customer account write offs, “holds” and meets reimbursement requirement for writing off bills. Assists legal team in preparing formal responses for Interrogations and Request for Production of Documents related to lawsuits. Attends meetings as necessary with Risk Manager and attorney. Manages the processes related to the claims administration. Assists with entering claims data into software system and preparing reports for actuarial review. Works with Risk Manager in reviewing claims on a quarterly basis. Prepares files for and meets with insurance adjusters on liability claims. Physical Demands Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time Weight Carried: Up to 20 lbs, Occasionally 0-30% of time Vision: Heavy, Constantly 66-100% of time Kneeling/Stooping/Bending: Occasionally 0-30% Standing/Walking: Occasionally 0-30% Pushing/Pulling: Occasionally 0-30% Intensity of Work: Occasionally 0-30% Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. NGHS: Opportunities start here. Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status. Opened in 1951, Northeast Georgia Health System (NGHS) is a non-profit community health system on a mission of improving the health of our community in all we do. Our team cares for more than 1 million people across the region through four hospitals and a variety of outpatient locations. Northeast Georgia Medical Center (NGMC) has campuses in Gainesville, Braselton, Winder and Dahlonega – with a total of more than 700 beds and more than 1,100 medical staff members representing more than 50 specialties. NGHS also encompasses Northeast Georgia Physicians Group, a multi-specialty group with more than 65 locations, and The Heart Center of Northeast Georgia Medical Center, a cardiology practice with more than 15 locations.