Billings Clinic Risk and Claims Specialist in BILLINGS, Montana
You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006.
And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!
You can make a difference here.
Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital.Learn more (https://www.billingsclinic.com/about-us/) about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.
We provide a comprehensive and competitive benefits package to all permanent full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more.Click here (https://www.billingsclinic.com/careers/employee-benefits/) for more information ordownload the Employee Benefits Guide (https://ncstoragemlbillings.blob.core.windows.net/public/2021%20Billings%20Clinic%20Staff%20Benefits%20Guide.pdf) .
Magnet: Commitment to Nursing Excellence
Billings Clinic is proud to be recognized for nursing excellence as a Magnet®-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here (https://www.billingsclinic.com/campaign-landing-pages/magnet/) to learn more!
All new employees must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more!
Risk and Claims Specialist
RISK MANAGEMENT (BILLINGS CLINIC 1045 N 30TH BUILDING)
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours (Non-Exempt)
Starting Wage DOE: $22.18 - $26.06
Under general supervision, the Risk & Claims Specialist is responsible for providing administrative, secretarial, and database support for the Risk Management and Patient Relations Department and regional affiliate locations to support risk functions as indicated by Risk Management Director. The Risk and Claims Specialist assists in coordination of the daily activities of the Risk Management Department including receiving, triaging, and resolving patient complaints, inputting data into department software systems, developing reports, and assisting in coordination of medical malpractice claims at the direction of the Risk Management Director and/or the Risk and Claims Coordinator and Risk and Claims Analyst. Works closely with Billings Clinic and its affiliate sites to coordinate general and medical malpractice claims insured by Billings Clinic’s insurance company. Participates in the day-to-day coordination of the department’s fiscal assets and personnel support. Responsibilities include the development and maintenance of essential databases and reporting processes for risk management related initiatives, accessing, extracting, synthesizing and verification of clinical and financial information, and report generation to support identification and evaluation of trends. Acts as a resource to diverse types of end users, employees and leadership regarding data support services and outcomes. Participates in assisting the Risk Management Director in the development of operating and capital budgets for related sites. May represent the department and/or affiliate sites in non-clinical committees.
Essential Job Functions
• PATIENT SAFETY
• Works collaboratively with Patient Safety to fulfill the organization’s and affiliate sites strategic initiatives for patient safety management and improvement. This includes:
• participating in the education of and assisting Risk Management Director, Risk and Claims Coordinator and Risk and Claims Analyst and affiliate site Leadership teams in identifying and capitalizing upon opportunities for improvement
• Participates in identification and arranging for consulting assistance from internal or external sources as required to meet the needs of the Risk Management Committee, medical staff, or others requiring patient safety and risk management education.
• Assists in establishing and maintaining processes to measure customer satisfaction including analysis, routine reporting of complaint and grievance data, and recommendations on findings
• Assists in the development and delivery of annual training and education in FDA reporting.
• Coordinates dissemination of FDA recalls to pertinent departments within the organization.
• (Project Management, Safety, Organization Patient Safety Methodologies)
• RISK MANAGEMENT / PATIENT RELATIONS
• Participates in the collaborative design, coordination and management of an organizational wide Risk Management Plan that organizes both risk prevention measures and claims processing and management systems for Billings Clinic and regional affiliate sites. (Project Management, Risk Management, Risk Management Services)
• Acts as one of the primary departmental contacts for resolution of customer complaints and issues related to the quality of patient care and/or services, threats of legal action, and imminent safety/risk situations including mandatory reporting to FDA for potential and/or serious patient/employee injury or death resulting from a medical device. Adherence to state and federal disclosure of health information obligation and restrictions is critical. Maintains all legal case files and ensures maximum protection from discoverability. (Quality/Regulatory, Customer Service, Service Recovery)
• Actively participates at the direction of the Risk Management Director and/or Risk and Claims Coordinator in the assessment and evaluation of liability insurance coverage. (Quality/Regulatory, Liability Insurance, Insurance Assessment)
• Assists Risk Management Director and Risk and Claims Coordinator and Risk and Claims Analyst with coordination of Billings Clinic and affiliate site medical malpractice claims.
• (Quality/Regulatory, Legal, Affiliate Malpractice Claims)
• Participates in the development and maintenance of risk management profiles on individual physicians and ensures integration of that information into the credentialing process in compliance with requirements for state and federal agencies, affiliate site and Billings Clinic. (Quality/Regulatory, Regulatory Readiness, Physician Risk Management Profiles )
• Receives, inputs, codes, monitors follow up and closes complaint and grievance reports. Responsible for overall maintenance of the Feedback system. (Quality/Regulatory, Quality Review, Occurrence & Complaint Reports)
• Works with the Risk Management Director, Risk and Claims Coordinator and Risk and Claims Analyst in the development and communication of department specific, Billings Clinic and/or affiliate site policies and procedures. Coordinates closely with the Risk Management Director, Risk & Claims Coordinator and Risk and Claims Analyst on complex issues. (Quality/Regulatory, Policies & Procedures, Policy Development or Revision)
• Works directly with the Risk Management Director in both short, and long-term planning for the department and/or affiliate. Participates in development of the department annual budget; maintains budget variances within acceptable standards. (Resource Management, Department Planning, Assists with Department Budget)
• Organizes, prioritizes, and performs data management project work to support the organizational strategic initiatives for risk management. Works with a variety of departments to access, extract, synthesize, and verify clinical and financial information. Summarizes, formats and generates a variety of monthly, quarterly and annual reports to support identification and evaluation of trends in risk management and patient relations. (Project Management, Analyze, Data Management)
• Maintains database integrity to ensure authenticity, confidentiality, and effective utilization in support of the organizational strategic initiatives. Coordinates and accesses information through the use of various databases, software applications such as statistical packages, database tools (Access & Excel), clinical/financial databases and safety databases. (Information Systems, Database Development & Maintenance, Maintains Database Integrity)
• 4 Year / Bachelors Degree in healthcare related field preferred or other related field required
• 3 years experience in the health care industry including two years of progressively more responsible work in risk management
Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered
Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more atwww.billingsclinic.com/aboutus (https://www.billingsclinic.com/about-us/)
Billings Clinic is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.