Central Florida’s premier multi-specialty medical group
Comprehensive Employee Benefits such as Educational Reimbursement
CREATION Health employee wellness and lifestyle programs
Positive working climate to support a work life balance
Work Hours/Shift: Mon-Thurs 8:30-5pm, Fri 8:30am-3pm
You Will Be Responsible For:
Notifies the Risk Management Administration regarding any specific risks to other AHMG patients, visitors, or staff, as identified through the management of claims
Organizes and manages medical malpractice subpoenas and depositions to include providing assistance/support to employees
Efficiently manages AHMG professional liability according to established protocols
Protects the assets of AHMG through effective management of internal and AHS claims
Works cooperatively with AHS Risk Management and Defense Attorneys in the management of all AHMG and general liability claims for AdventHealth Medical Group
Monitors and investigates all potential claims, as appropriate
Works collaboratively with the Associate Director of Risk Management to resolve claims with patients in a timely and professional manner including, but not limited to: denial, negotiation, and/or settlement
Assesses liability, damages, and value of potential claims
Monitors and reports the following data related to AHS: number of PCE’s and claims submitted, payouts and loss runs to ensure appropriate and timely payment of claims
Monitors, analyzes, and reports aggregate claims data to AHMG Executive Leadership under the direction of the Director of Risk Management as requested
Facilitates Amendment 7 and discover requests for claims are consistent with the intent of the Patient Safety and Quality Improvement Act
What You Will Need:
Associates degree, business or healthcare-related field OR
Minimum of two years of experience in Risk/Claims Management or Paralegal
Bachelor’s degree in business or healthcare related field, preferred
Active Florida State license as Health Care Risk Manager, preferred
Florida license in Risk Management, preferred
Florida Claims Adjuster, preferred
Understands medical technology and terminology, medical procedures/treatments, their usual risks, and expected outcomes.
Understanding of conflict resolution and grievance management techniques.
Knowledge of federal legislation, state statutes, and case law relevant to risk management and patient safety activities.
Understanding of the claims/litigation prevention and management process.
Proficient in computer software programs utilized in the department.
The Claims Management Coordinator (CMC) is responsible for assisting in identifying claim related risks to Adventhealth Medical Group, its physicians, staff, and visitors. The CMC ensures all AHS claims needs are handled in an efficient and timely manner and in compliance with established protocols. The CMC maintains files and organizes internal claims issues of all AHMG internal claims with the collaboration of the Associate Director of Risk Management. The CMC manages AHS insurance requests related to claims validation and physician malpractice renewals and changes.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.