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A cover letter is required for consideration for this position and should be attached as the first page of your resume. The cover letter should address your specific interests in the position and outline skills and experience that directly relate to this position.

Job Summary

Clinical Risk is looking for a qualified candidate for the position of Administrative Specialist Intermediate Healthcare. This role supports the Claims team in the review of patient events. This individual would have a direct line and support the Chief Risk Officer and Risk team.  This individual must be able to work independently and have knowledge of CMS Regulations as it relates to grievances within our institution. The Administrative Specialist is the center of the Claims Team and supports them in their processes, timelines, reviews, and responses.

Responsibilities*

  • Reviews patient claims, event documentation and correspondence by the Risk Consultant Team to ensure they are appropriate, complete, and accurate to provide initial triage of claim impact. Assess and analyze information and provide initial response. Manages or escalates as appropriate using subject matter knowledge in health care and insurance claims.
  • Reviews Risk Consultant department workflow with an innovative perspective, identifying areas of improvement. Outlines alternatives and recommends improvements to define needs, identify training gaps and facilitate process changes.
  • Collaborates with leadership, patient relations and internal consultant team to ensure internal guidelines and policies and external regulations are being followed therefore reducing risk for the organization. Identify gaps and develops documentation to assist in ensuring accurate processes.
  • Manages the day-to-day business activities of the Chief Risk Officer (CRO); demonstrates the ability to handle confidential information with discretion; prioritizes and handles internal and external correspondence; conducts investigative work on less complex claims to a substantial degree.
  • Opens new case files, notifies appropriate departments, assembles and maintains highly confidential legal and patient files, overseeing the progress of claims investigations and coordinating the activities of the office’s claims work; assists in the research and/or preparation of written rationale of claim decisions.
  • Assists Michigan Medicine’s clinical departments in educational and risk management activities including design and production of Grand Rounds and other educational activities;
  • Participating with due diligence in prospective and pending professional service contracts.
  • Assists Consultants and reviews less complex cases with Patient Relations Coordinators to handle claims as appropriate.
  • Applies for, and participates in government and philanthropically-sponsored research as it relates to the study, expansion and growth of the Michigan Model. Researches, collects data and drafts grant application for submission. Conducts prospect research to identify, cultivate and solicit new grants.
  • Constructs visits by, and manages itineraries for a steady stream of visiting organizations from the United States and international groups as diverse as the Peking University Health Sciences, the National University of Singapore, the National Health Service of Great Britain, the National Health Service of South Africa and others.
  • Managing new and ongoing relationships with national and international groups like those above.
  • Conducts independent background research, conducts information queries and produces profiles related to visiting delegations and Michigan Medicine clinical partners.
  • Initiates, composes, and edits documents, communications and e-mails to both internal and external stakeholders regarding matters of a highly sensitive or confidential nature. Exercises high level thinking skills and strategic problem solving skills, utilizing independent decision making skills.
  • Exercises high level communication skills, verbal and written, expertly communicating matters of a highly sensitive or confidential nature to both internal and external stakeholders, including but not limited to patients and/or their representatives, clinicians, staff, attorneys, CMS, Third Party Payers. Adapt and/or modify various communications meeting the needs of the audience.
  • Monitors and enforces timelines for responding to grievances and complaints. Adhere to high standards of organization to ensure that internal and external agency deadlines are met.
  • Utilize Microsoft Access, Excel, and Radical Logic/Patient Safety Report System for data analysis, updates, and queries of a highly confidential nature. Create or modify reports using independent discretion.
  • Evaluates current practices and policies within the department, identifying barriers and making recommendations for improved effectiveness, efficiency, and customer service.  Adapt or create new practices and policies as needed. Communicate modifications and/or changes to all involved parties. 
  • Meet with Risk Consultants and the Chief Risk Officer to address services recovery needs.

Required Qualifications*

The Office of the Executive Director for Patient Relations and Clinical Risk/Chief Risk Officer supports the University’s educational mission offering various kinds of support directly to the University of Michigan’s Medical School, Nursing School, School of Public Health, Business School, Law School and science-focused undergraduate groups in various ways, including: hosting students from the various schools as interns and supporting student research projects.

  • Bachelor's Degree required.
  • Paralegal Certificate and background highly desired.
  • 3 years of Risk Management/Claims/Insurance experience.
  • Knowledge of legal risk and regulatory/statutory guidelines, HIPPA, privacy, Affordable Care Act, etc.
  • Effective interpersonal and communication skills required. 
  • Must be extremely strong in oral and written communication skills. 
  • Working understanding of principles, practices, and procedures of both Michigan Medicine and the Patient Relations & Clinical Risk office.
  • Willingness to perform a wide range of tasks. 
  • Must have flexible scheduling with occasional weekend and after hours work as necessary. 
  • Excellent organizational skills and ability to problem solve issues without supervision. 
  • Considerable skill in Microsoft Office (Word, Excel, Access, Publisher, Visio, and PowerPoint) in a highly active environment.
  • Experience in Radical Logic/Patient Safety Reporting System. 
  • Experience using database programs a plus. 
  • Critical thinking skills strongly desired.
  • Public speaking experience strongly desired.
  • Good attendance history required.
  • Past claims or litigation experience and familiarity with medical and legal terminology are highly desired.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings.  Background screenings are performed in compliance with the Fair Credit Report Act.

Application Deadline

Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.