Risk Adjustment Coding Jobs in Maine

Northern Light Health

Department: Patient Safety

Position is located: Mercy Fore River

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

Summary

The Risk Management Specialist works under the general supervision of the Director of Quality and Director of Patient Safety at Northern Light Health. The Risk Management Specialist serves as a primary point of contact regarding risk. The incumbent is responsible for the development and ongoing review of hospital-wide clinical risk and claims management. The incumbent will assist the Director in coordinating in-depth risk assessments of all hospital departments and for overseeing the ongoing education of hospital and medical personnel related to risk prevention and claims management. The Risk Management Specialist will participate in patient safety initiatives; they will identify event trends, develop risk mitigation plans, and will collaborate with the multidisciplinary team to create, and manage process improvement initiatives for better patient outcomes. The Risk Management Specialist will also manage event investigations, to include RCAs and will complete all necessary communication, documentation and reporting while establishing strong action plans. The incumbent may have access to highly confidential patient, employee and/or proprietary information, and must handle & protect the information in accordance with hospital and system policies, HIPAA requirements, and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. The position dual reports to the Director of Patient Safety at Northern Light Health.

Responsibilities:

• Facilitates hospital-wide proactive assessment activities including Proactive Risk Assessments, Failure Mode Effect Analyses and Apparent Cause Analyses.
• Manages all Sentinel Event reporting, processes and follow up.
• Manages retrospective reviews of safety events, including incident reports and Root Cause Analysis of significant and Sentinel Events, including coordination and follow-up with the State Sentinel Event Team.
• Serves as the point of contact for risk and patient safety committees and work groups and provides requested data associated with such groups.
• Manages the Risk Management program; ensures that robust processes for risk monitoring, risk prevention, event mitigation, and event reporting are in place.
• Leads staff development activities to support risk management competency, reporting culture, and risk prevention and mitigation activities.
• Seeks opportunities to meet learning needs through seminars, certification, and literature.
• Acts as a liaison to medical malpractice insurers and manages patient safety related claims or potential claims.
• Will participate in patient safety initiatives aimed at reducing harm and improving patient outcomes and will identify opportunity for process improvement initiatives based upon current trends and risk.
• Works closely with process improvement initiatives, and/or team members to ensure smooth transition from risk mitigation to proactive improvement and prevention.
• Other duties as assigned.

Competencies and Skills:

• Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
• Acts Strategically: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.
• Electronic medical record software.
• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
• Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
• Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
• Fosters Innovation: Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.
• Influences and Inspires: Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.
• Ability to understand the language used to precisely describe the human body including its components, processes, conditions affecting it, and procedures performed upon it.
• Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
• Word processing, spreadsheets, data entry, database experience and other computer related skills.
• Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.
• Presentation software with the ability to create presentations with the ability to incorporate animation, audio, video, time delays, as well as designing themes and variants with animations and effects.
• MS Teams
• Word process application with the ability to create and edit documents, format, use tables, apply footnoting, create table of contents and mail merge techniques.
• Multi-line phone, scanner, photocopier, fax, and internet.
• Promotes Health and Safety: Promotes a healthy and safe environment for patients, employees and visitors. Advocates and models healthy physical and mental health behaviors even in challenging circumstances. Sets high quality standards and strives for continuous improvement and quality assurance by reporting and encouraging others to report near misses and safety issues.
• Public Speaking
• Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability.
• Seeks Process Improvement & Applies System Thinking: Possesses and gains insight into situations, problems and processes. Understands the interconnection between organizational elements. Deconstructs problems and systematically investigates the various components. Considers the impact of actions on the entire process/system. Detects problems and opportunities, recognizes important information, and links various data to trace potential causes and relevant details.
• Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.
• Business intelligence and data analysis software.
• Zoom
• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

Required Associate's Degree + 4 years' experience.

Required Experience

5 year/years of Relevant Work Experience

Working Conditions

• Potential exposure to abusive and/or aggressive people.
• Potential exposure to diseases or infections.
• Work with computers, typing, reading or writing.
• Prolonged periods of sitting.