Bon Secours Mercy Health

Risk

• SUMMARY Supports clinical and nonclinical risk management and the coordination of the centralized insurance program. Lines of business include professional liability, general liability, executive risk, property, cyber liability, crime, reinsurance for the captive, auto, aviation and others. The Risk & Insurance Manager independently manages the program/facility loss prevention strategies and initiatives, established in conjunction with the System Risk Director, and serves as a subject matter resource for assigned facilities and functional areas as directed. The Risk & Insurance Manager analyzes risk issues and directs and organizes loss prevention strategies and initiatives for assigned program or facility including proactive risk activities such as risk assessments, educational programs, consultations and ensuring compliance with the multiple laws and regulations affecting patients, visitors, employees and the community we serve. The Risk & Insurance Manager is responsible for keeping all Administrative and Clinical Leaders as well as Market/System Risk apprised of significant events and Risk Management activities within the scope of assignment. ESSENTIAL JOB FUNCTIONS Supports the strategic plan to address risk assumption/risk transfer and loss prevention activities associated with both physician and non-clinical risks. Participates in collection of underwriting information including collecting data needed for the captive, reinsurance, physician, and multiple commercial insurance policy renewals and bonds throughout the year and also maintains this data for historical purposes. Assists with evaluation of risk and the physician onboarding process into the captive. Maintains databases of insured entities, properties, vehicles, drivers, physicians, etc. in the risk management information system. Maintains schedules of insurance, policies, premiums, policy summaries, etc. Assists with physician credentialing and loss history requests. Participates in the risk analysis to determine effective loss prevention activities then implements loss prevention activities, including education, related to both clinical and non-clinical policies as directed by the System Director. Assists with ensuring compliance with patient compensation funds and other special state funds. Processes and tracks invoices, premium payments, premium returns, etc. Works with facilities, practice managers, real estate, finance, human resources and other internal departments to manage all certificate requests. Works on special projects and assists as needed. Must possess effective communication skills, ability to work well with others, professionalism, and a positive attitude. EMPLOYMENT QUALIFICATIONS Required Minimum Education: Bachelors Field of Study- Risk Management, Healthcare, Business, or related field Licensure/Certification Required : CPHRM (within 4 years of hire) Licensure/Certification Preferred : CPCU, ARM or similar certifications Minimum Years and Type of Experience Required : 3+ years in healthcare provision or administration, insurance, loss prevention or related field. Or combination of post-secondary education and experience in lieu of a degree. Minimum Years and Type of Experience Preferred: 5+ years in healthcare provision or administration, insurance, loss prevention or related field. FUNCTIONAL SKILLS REQUIRED Analyzing data or information Proficient in Microsoft Office Planning skills Organizational skills Data entry Electronic file management Analysis of risk Submit payments and credits for processing Assist with loss prevention Collection of data INTERPERSONAL SKILLS REQUIRED Attention to detail Critical thinking Team player attitude Responsible Dependable Motivation and work ethic Flexibility and adaptability Openness to feedback and ability to accept and support leadership decisions even if not in total agreement Positive attitude Excellent interpersonal skills with the ability to communicate effectively and actively listed in concerns identified

Risk Manager

Account Manager

• Primary Function/General Purpose of Position In collaboration with Market President, the Physician and Provider Relationship Manager is responsible for incremental improvement of in-network utilization through growth in new patient referrals across the BSMH Product Portfolio.
• Serves as strategic counsel to Market President, System Strategy and Marketing, Medical Group, and Population Health related to incremental growth opportunities and barriers.
• Acts as strategic growth expert to service line leaders as well as BSMH specialists building a new practice, collaborating to create a high impact growth plan with measurable targets.
• Using national, state, and local trends, benchmarks BSMH performance in KPIs most relevant to growth in product portfolio, identifying gaps and recommending matters most initiatives to market leadership.
• Conducts face to face visits with physicians, providers, and influencers to inform them of new services and/or changes in care delivery to optimize care coordination of in-network offerings for empaneled patients.
• Identifies barriers and facilitates resolution improving care delivery, often resulting in substantial process change and/or new service offerings.
• Identifies physicians and providers at risk of leaving network and partners with market leadership to create and operationalize a retention plan.
• Convenes market stakeholders to discuss and address competitive threats, performance improvement opportunities, and product differentiators to enable incremental growth.
• Aggregates and interprets multiple sources of data to inform creation and execution of strategic call plan, demonstrating measurable growth impact to product portfolio.
• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Physician and Provider Relationship Manager – Strategy

Manager

• Provide clinical care management services to identified eligible patients; coordinating care to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care.
• Perform standardized comprehensive needs assessment, identifying and addressing barriers to care and aligning patients with available benefits and resources.
• Collaborate with patient, provider and care team to develop and implement a plan of care to ensure medically appropriate cost-effective care.
• Utilize Motivational Interviewing techniques to activate patients in self-management of their chronic conditions.
• Maintain a caseload of patients according to department policies; identify, enroll and manage patients in program for Transitions of Care/Complex Case Management/Chronic Disease Management.
• Develop and implement care plans to maximize healthcare outcomes and facilitate wellness with periodic review and update according to department protocols.
• Perform medication review and teach-back to ensure patient understanding and ability to adhere to medical regimen.
• Collaborate with PCPs, Specialists, and Hospitalists to effectively implement a patient-centered care plan.
• Perform patient outreach according to established protocols and document in electronic medical record.
• Identify, execute, and track needed referrals to care and community resources.
• Provide resource management to improve care, patient experience and reduce unnecessary cost and utilization: right care, right place, right time.
• Assist patient in advanced care planning to complete Advanced Directives.
• Document all communications with patient and/or care team in electronic medical record.

Registered Nurse (RN), Ambulatory Care Manager, Population Health

Technical Program Manager

• Leads internal audit projects according to the audit plan throughout the Ministry, including risk assessment, audit performance, follow-up and ongoing communication of risks, results and mitigation efforts.
• Develops appropriate documentation to support audit work performed.
• Responsible for ongoing communication and collaboration with key partners including (but not limited to) Compliance, Legal, Finance, IT and Revenue Cycle.
• This position is fully remote, however must adhere to these two qualifications: 1) Be located within the United States 2) Willing to work Eastern Time hours in accordance with our business.
• Assists in risk assessment process and preparation of audit plan that focuses on high-risk areas.
• Conducts independent audits according to the audit plan and develops appropriate documentation to support audit work performed.
• Measures and tracks the results of audits performed through action plan follow-up procedures.
• Prepares reports to management of findings and proposed action plans for each audit.
• Assists in the preparation of audit reports for presentations to management and governance; may present findings to management as appropriate.
• Communicates and prepares meeting agendas and status reports to facilitate discussion with immediate supervisor and upper management about audit activities in progress and emerging issues in a timely and proactive manner.
• Keeps current on industry trends and areas of interest through utilization of industry research and knowledge resources.
• Displays a commitment to excellence, accuracy and thoroughness in all activities, and searches for ways to improve and promote quality.
• Participates in department process improvement efforts.
• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Internal Audit Program Manager

Auditor

• Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors and audit protocols and the prevention of fraud, waste and abuse.
• Develops compliance monitors and audit protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare, State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based payment programs and/or other enforcement agencies on behalf of Bon Secours Mercy Health.
• Coordinates periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal and external third party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues.
• Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third party vendors to detect and trend potential claims and billing compliance issues relative to revenue cycle risk areas
• Assists in auditing and investigations requested by the System Director, Compliance.
• Assists in the development of compliance corrective action plans (CAP), oversight tools and technical edit enhancements to support revenue cycle services compliance and privacy efforts.
• Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation.
• Maintains awareness of fraud, waste and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking.
• Ensures that the System Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and/or deficiencies that could impact Bon Secours Mercy Health's public status.
• Develops educational content on documentation, coding, and trending of non-compliant activities to enhance compliance proficiency and competency, understanding of standards and the consequences of non-compliance.
• Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities.

Risk Manager

Physician and Provider Relationship Manager – Strategy

Registered Nurse (RN), Ambulatory Care Manager, Population Health

Internal Audit Program Manager

Compliance Auditor - Enterprise Risk