Hospitals Insurance Company has an exciting Clinical Risk Management Coder position available in their NYC office!
The Clinical Risk Management Coder is responsible for the review and analysis of medical malpractice claims from a clinical perspective, including the identification of contributing factors related to an event/claim, data classification and clinical narrative preparation. The Coder applies critical thinking and sound judgment in applying coding taxonomy consistently across multiple fact patterns. Works closely with CRICO’s Coding Manager to ensure inter-rater reliability within CRICO’s Comparative Benchmark System.
Reviews claim files and medical records to discern, identify and code claims with all pertinent data using CRICO clinical coding taxonomy in combination with ICD-9 and 10 classifications.
Reviews pleadings, expert reviews and relevant legal correspondence to discern issues in litigation and drivers related to agent of loss.
Creates a comprehensive clinical narrative of the care provided in each case reviewed.
Identifies the contributing factors related to the claim and care rendered.
Participates in periodic skill development and education sessions, including best-practice reviews, with CRICO management and bi-weekly coding conference calls.
Conduct various CRICO coding projects and provide support to other risk Management Department projects as assigned.
Conducts preliminary coding (cursory review) within two days of receipt of cases. This involves the coding of three categories; allegations (if applicable), injury/severity, primary responsible service and confirm responsible service.
Conducts full coding (extensive review) a minimum of 50 cases per month. This involves the coding of 14 categories including review of medical records, pleadings, defense counsel analysis/interviews, expert reviews, ICD-9 and 10 codes, etc.
Conducts final coding of closed cases within established deadlines.
Strong clinical background in healthcare, including demonstrated knowledge of medical terminology.
Broad knowledge of healthcare organizations/providers, clinical risk management, safety, regulatory requirements, and health care quality and accreditation functions.
Strong analytical skills with demonstrated ability to conduct systematic and methodical analyses. Ability to read claim files and medical records and synthesize the essence of the event.
Attention to detail, thoroughness and demonstrated ability to consistently deliver accurate work products.
Excellent organizational skills, with demonstrated ability to independently set systems in place to track projects and work, and to consistently follow through on task completion.
Ability to manage multiple priorities, prioritize work according to urgency and importance, and consistently meet deadlines in a fast-paced work environment.
Ability to work with minimal guidance or direct supervision and make independent decisions.
Ability to maintain confidentiality of highly important and sensitive information.
Proactive; identifies work to be done and does it; looks forward to plan upcoming needs and work.
Strong interpersonal and communication (both verbal and written) skills.
Proficient in Microsoft Office products including Word, Outlook, PowerPoint and Excel.
Ability to travel to CRICO’s annual Collaborative, generally held in the greater Boston area.
Education and Experience Required
RN, PA or MPH. Bachelor’s degree preferred.
2-5 years’ experience in hospital critical care and/or risk management including exposure to medical malpractice litigation in NY and the types of pleadings utilized.
Experience in conducting root cause analyses and/or healthcare related investigations helpful.
Preferred background includes experience in investigating malpractice claims or adverse events.
Internal Number: SRA2
About Hospitals Insurance Company
Hospitals Insurance Company (HIC), a New York State licensed insurance company with offices in New York City and White Plains, NY, provides professional liability, general liability and other insurance coverages for hospitals, long-term care facilities, physicians, and health care professionals throughout New York State. Since 1987, HIC has served the insurance needs of the medical community with a strong commitment to personal service, competitive rates and security for its policyholders. With twenty-five years of experience in the business, HIC is one of the oldest healthcare professional liability insurers in the country.
HIC works closely with FOJP Service Corporation (FOJP), one of the largest insurance and risk management organizations in the country and a leader in the risk management community. Since 1977, FOJP has administered property and casualty insurance programs for a group of major hospitals, long-term care facilities, and social service agencies in the metropolitan New York area.
As risk management advisor to its clients, HIC has a deep interest in initiatives to reduce patient injury and improve clinical outcomes. In coordination with FOJP, HIC systematical...ly collects and analyzes data on incidents, losses and claims; helps identify potential hazards; investigates adverse patient incidents; and provides claims administration and litigation management services.
Hospitals Insurance Company is an Equal Opportunity Employer.