Patient Relations Specialist

Tufts Medicine•Lowell, MA

43d•$25 - $31

About The Position

This role focuses on developing and implementing programs to establish, maintain, and improve patient quality care standards. In addition, this role focuses on performing the following Performance Improvement/Quality duties: Identifies and executes performance improvement and quality opportunities across the enterprise, enabling successful transformations and driving cost savings, process and product quality, and achievement of business goals. Responsibilities also include partnering with business leaders to provide expert insight on existing processes and procedures, applies process improvement methodologies to achieve PI/Quality objectives, and builds process improvement capabilities. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation. Job Overview Under general supervision, manages, investigates, and responds to patient complaints and grievances for both hospital and clinic patients. Highly visible on all hospital units and throughout the campus and works with various managers and physicians to de- escalate angry patients and families. Provides support and resource services to patients and families. Provides support and resources services to patients and families of diverse populations. Responsible for recording and reporting all interactions and maintaining appropriate documentation while maximizing patient satisfaction. Works closely with risk management department on sever grievances involving litigation. Assures the organization remains compliant with the CMS regulations and Joint Commission Standards relating to the disposition of patient grievances.

Requirements

Associate's degree in healthcare management.
Two (2) years of related experience in the healthcare industry.
Working knowledge of CMS and JCAHO standards related to patient grievances
Analytical ability is required to investigate patient complaints/grievances and prepare reports.
Must have excellent interpersonal skills to communicate with patients, families, medical staff to effectively deal with conflicting views or issues and mediate fair solutions.
Excellent well developed writing skills required.

Nice To Haves

Bachelor's degree in healthcare management.
Three (3) years of related experience in the healthcare industry.
Board Certified Patient Advocate (BCPA).

Responsibilities

Processes and follows up with patient inquiries via, email, phone, fax, mail and from internal resources.
Acts as liaison and support for patients and/or families with questions, seeking help or having difficulty navigating the healthcare system through in-person visits, telephone, email, or patient surveys.
Serves as the patient's representative in communicating patient concerns regarding care or service to involved departments and services. Utilizes electronic feedback system to record activity.
Investigates complaints through chart review, interviews with clinical leadership and staff, and topic research. Compiles findings.
Communicates findings back to patient/family. Develops response letters to complaints and grievances as defined by DPH and CMS, respectively.
Provides recommendations for the most efficient resolution of patient complaints
Maintains timely and accurate log of complaints and complete files including complaint, investigation, and follow up as required by the DPH and CMS.
Helps prepare reports on Patient Relations activity for internal quality committees and regulatory reporting.
Determines reimbursement for patient lost items and coordinates reimbursement for critical personal items such as glasses, dentures, hearing aids.
Participates in and utilizes training programs that assist and promote effective patient service techniques.
May provide assistance to patients and appropriate hospital staff seeking information concerning billing and collection problems. Researches accounts to assess and resolve problems and ensures that issues are addressed in a professional, efficient and courteous manner.
May serve as an active member of the Ethics Committee.