Risk Manager

Albany Medical Center•Albany, NY

21d•$94,957 - $147,183

About The Position

The Risk Manager represents Albany Medical Center through involvement in quality- and risk-oriented professional organizations, delivering presentations, publishing, and maintaining contacts with members of the business community and professional organizations. The position also plays an integral role in department and Center-wide special projects. The Risk Manager manages occurrence reporting, sentinel-event processes, loss-control activities, and safety and quality improvement work for an assigned service area. Responsibilities include facilitating event analyses and improvement teams, preparing debriefs and root-cause analysis reports, monitoring action plans, managing occurrence and quality data, overseeing safety workgroups, and completing failure mode and effects analyses. The role coordinates timely reporting of reportable events, responds to regulatory inquiries, develops early-warning and loss-control strategies, supports education and system-review processes, analyzes data, and liaises with regulatory agencies. The Risk Manager also supports service-area members involved in sentinel events, claims, or litigation. The role may require access to sensitive information, including HIPAA-protected health information and other information regulated by federal and New York State statutes. Workforce members must access only the minimum necessary information for assigned duties, limit use and disclosure to the intended purpose, and make reasonable efforts to protect information from unauthorized access and modification in accordance with Albany Med Health System policies and standards.

Requirements

Associate degree in a health care-related or business-related field; a high school diploma and four or more years of relevant experience may be accepted instead.
RHIT, RHIA, CCS, or CPC credential required.
At least two years of experience in auditing, compliance, and/or coding; alternatively, four or more years of relevant experience with a high school diploma may be accepted in lieu of an associate degree.
Knowledge of third-party billing regulations for hospital and/or provider reimbursement.
Experience and understanding of the CPT coding system.
Knowledge of medical necessity edits related to local and national coverage determinations (LCDs and NCDs), correct clinical initiatives (CCIs), and medically unlikely edits (MUEs).
Strong clinical knowledge and understanding of clinical documentation practices.
Excellent verbal and written communication skills.
Experience navigating an electronic medical record.
Strong critical-thinking skills.
Detail-oriented, with the ability to prioritize multiple tasks and projects with varying deadlines.
Collaborative team-player approach.
Experience using Microsoft Office products.

Nice To Haves

Bachelor’s degree in nursing.
Registered Nurse (RN) credential.
At least three years of experience in a clinical setting.
Epic experience.

Responsibilities

Represent Albany Medical Center through participation in quality- and risk-oriented professional organizations, presentations, publishing, and maintaining professional and business contacts.
Participate in special projects within the department and across the Center.
Manage the Occurrence Reporting System and sentinel-event process.
Facilitate assigned improvement teams in analyzing events, identifying process problems, redesigning work processes, and implementing potential improvements.
Prepare debriefs and root-cause analysis reports that meet regulatory requirements and support team problem-solving.
Design, develop, and implement processes for monitoring action plans.
Manage selection, preparation, and dissemination of occurrence and quality data and reports using statistical process control and quality assurance concepts.
Manage events and safety occurrences within the assigned service area and follow sentinel-event protocol.
Complete root-cause analysis within Department of Health guidelines and departmental protocol, and report to the Department of Health immediately upon completion.
Manage the Sentinel Event alert process.
Oversee Culture of Safety workgroups.
Complete failure mode and effects analyses and comply with regulatory requirements.
Manage the reportable-event process, identify reportable events within the service area, and report them in a timely manner.
Respond to inquiries from regulatory bodies concerning the service area.
Design, develop, and manage an early-warning system for the service area.
Manage loss-control strategy development for the service area.
Manage, design, and develop risk-management educational efforts for the service area.
Manage, design, and develop system-review processes for service areas.
Assist with and manage data analysis within the service area.
Liaise with the Department of Health, Office of Mental Health, DNV, and other agencies as necessary.
Provide support and advice to service-area members involved in sentinel events or claims and litigation.
Protect sensitive information by limiting access, use, and disclosure to the minimum necessary and following applicable policies and standards.