Risk Management Assistant

Risk Management Assistant

The Risk Management Assistant is responsible for supporting the development, implementation, and monitoring of risk management programs and policies at VCU Medical Center. This role ensures that organizational operations align with regulatory requirements and internal policies. The Assistant works closely with various departments to identify, assess, and mitigate potential risks. The role is responsible for conducting the investigation and submission of patient belonging claims, ensuring compliance with regulatory standards and internal policies.

Clerical Staffing Coordination

Develops office guidelines and processes, monitoring and revising processes as needed. Maintain staffing and on-call calendar with in the department. Triage and assign incoming calls and emails.

Operations Support for the Department

Coordinate and support risk management initiatives across departments. Assist with risk assessments and developing mitigation strategies. Monitor compliance with risk management policies and procedures. Maintain records of incidents, insurance investigations and claims, and risk reports. Assist in preparing risk analysis reports for leadership. Support training programs related to risk awareness and compliance. Collaborate with legal, Security, and operations teams to review processes and identify potential liabilities. Stay updated on relevant laws, regulations, and best practices in risk management. Lead the process of managing investigations and submission of assigned insurance claims. Participate in audits and safety improvements.

Claim Investigations

Coordinate and manage belonging and fall claims investigations, including assignment of cases to internal or external staff or investigators. Review claims for accuracy and completeness. Interview staff and analyze medical records and provider documentation to validate claims. Collaborate with providers, patients, legal teams, and regulatory agencies during investigations. Prepare detailed investigative reports and submit summaries for claims resolution and review. Ensure compliance with HIPAA, CMS, and other healthcare regulations. Maintain accurate documentation and case files in claims management systems. Monitor trends in claim discrepancies and recommend process improvements. Educate and support staff on investigative procedures and compliance standards. Assist in audits and regulatory reviews as needed.

Administrative Support

Completes and processes all certified and regular mailings. Processes recall notices and sends to appropriate departments. Maintains department SharePoint site including updating posted documents. Creates and edits documents, forms, and presentations.

Miscellaneous Responsibilities

Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the department. Assists team members. Accepts alternate assignments, as required, graciously. Provides education to units/departments when requested.

Employment Qualifications

Required Education: Bachelor's degree in healthcare administration, Business, Project Management, or related field from an accredited program

Minimum Qualifications

Years and Type of Required Experience: Minimum of two (2) years of previous administrative work experience in an office setting. Previous experience with or knowledge of insurance or medical claim investigation and submission. Previous experience with Microsoft Office applications (Excel, Outlook, PowerPoint, etc.) and Adobe Pro.

Other Knowledge, Skills and Abilities Required: Previous experience in customer service. Ability to manage multiple investigations and projects and meet deadlines in a fast-paced environment.

Other Knowledge, Skills and Abilities Preferred: Previous experience in a health care setting. Strong written and oral communication skills. De-escalation skills/experience. Strong analytical and critical thinking abilities. Ability to regularly exercise discretion, independent judgement, and decision making. Ability to work independently and within a team environment. Strong interpersonal, time management, and organizational skills. Project management and communication with a variety of individuals/entities. Combination of education and experience in lieu of a degree.

Working Conditions: Periods of high stress and fluctuating workloads may occur. General office environment. May be exposed to verbal abuse. May be exposed to high noise levels and bright lights. May be exposed to limited hazardous substances or body fluids. * May be exposed to human blood and other potentially infectious materials. * May have periods of constant interruptions.

* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

Physical Requirements

Physical Demands: Lifting/Carrying (0-50 lbs.), Push/Pull (0-50 lbs.), Stoop, Kneel, Squat, Crawling, Climbing, Balance, Bending. Work Position: Sitting, Walking, Standing.

Additional Physical Requirements/Hazards

Physical Requirements: Hear alarms/telephone/tape recorder

Hazards: N/A

Mental/Sensory Emotional

Mental/Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking. Emotional: Fast pace environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.