Claims and Insurance Coordinator
4 weeks ago
As Mount Sinai grows, so does our legacy in high-quality health care.
Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.
Culture of Caring: The Sinai Way
Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.
Position Responsibilities:
- Directs risk management calls for assistance to the appropriate individual or department for resolution.
- Demonstrates an understanding of risk management functions in daily work.
- Demonstrates the ability to handle confidential and sensitive data in daily work.
- Manages and processes requests for reimbursement for lost valuables and other personal belongings. Documents payments in HAS Incident Report system.
- Acts as system administrator for HAS database.
- Notifies insurance companies of potential and actual claims at the direction of the Interim Director, Claims & Insurance or the Director.
- Keeps all loss runs up to date by entering all legal bills, fees and indemnity payments with two days of payment.
- Provides loss run reports to insurance representatives and actuarial services as required.
- Completes all check requests for payments related to claims in compliance with captive/trust fund policies. Maintain appropriate copies with each claim file.
- Copies checks received from bank and maintains in appropriate claim file. Forwards checks with copy of invoice to vendors.
- Acts as a liaison with hospital departments so that requests for records/documents related to claims investigation and discovery are produced timely and properly secured.
- Acts as a liaison with defense attorney firms so that schedules for pre-mediation conferences, mediations, pre-deposition conferences and depositions are managed appropriately. Coordinate contacting personnel as necessary.
- Reviews medical records and other documents to compile list of personnel involved in care of patients related to claims.
- Works with key department directors and employees in scheduling all insurance and attorney interviews. Obtain last known addresses and phone numbers for personnel no longer employed.
- Communicates with patients and visitors regarding complaints and assist in resolution. Communicates with other departments to insure resolution.
- Sets up claim files in paper format with clearly defined sections for easy retrieval.
- Sets up claim files in HAS system and attach digital copies of all pertinent documents (i.e.: Legal filings, Contracts, Insurance Certificates, etc.)
- Maintains digital files of all e-mails/digital materials for each claim in separate digital files.
- Maintains all claim files in a secure confidential matter.
- Burns CDs and DVDs copies of all digital content received or medical records related to claims and provide to TPA and attorneys.
- Assists in the collection of discovery information including but not limited to insurance information, policies, procedures, job descriptions, licensing information, medical records and billing information.
- Assists in answering of Interrogatories. Insure final answers from attorney include the correct information that was provided to them.
- Follows-up on necessary responses required by legal correspondence. Prepare written responses for Manager, Claims and Insurance and Director as needed.
- Places all medical records, bills, films, pathology specimens, etc. related to claims on legal status.
- Locks all legal records in EPIC. Unlock as necessary for investigational and billing reviews.
- Notifies Medical Records to Flag records on potential claims as necessary. Attach email of notification to incident reports in HAS system.
- Obtains lists of all requests for records by attorneys and patients on monthly basis and check for any potential claims.
- Provides information for closed claim reports and NPDB reporting to TPA.
- Submits queries to CMS and create quarterly reports to CMS for required Medicare Secondary Payor reporting.
- Enters and updates all reserves and settlements for claims in HAS system.
- Scans and attaches supporting documents for incidents in HAS system.
- Creates reports from Incident and Claim data in HAS system as required. (i.e.: Legal Hours Paid, Incidents per location, etc.)
- Maintains an organized file listing of all closed claims and incidents sent to storage for easy and efficient retrieval.
- Assists Performance Improvement and Infection Control with sending files for archive storage and retrieval of files.
- Assists Manager of Claims and Insurance with any/all insurance applications. Requests required data from all other departments and compile in application as necessary.
- Maintains well organized insurance notebooks and files for all insurance coverages.
- Acts as a notary for all legal documents requiring a notary seal.
- Provides responses to requests for claims history and insurance certificates for employed health professionals and contracted providers covered under SIR.
- Provides employed practitioner claims history, AHCA reporting and Code 15 reports to Medical Staff Office for reappointments.
- Coordinates addition and deletion of physicians/allied health to med mal insurance with insurance broker.
- Maintains files on each insured physician with updated certificates and contracts. Provides copies of certificates to medical staff office and physician practices as requested.
- Maintains updated list of all employed/contracted physicians/allied health. Requests updates as expiration dates approach.
- Maintains accurate lists of all properties, insured drivers and vehicles. Updates/confirms list once per year with department directors.
- Maintains up to date grids for all insurance coverage's and premium payments.
- Takes meeting minutes and prepares agendas for key meetings as assigned. Copies and prepares packets for meetings.
- Licensed as Risk Manager in the State of Florida preferred
- College 2-4 year degree
- Minimum two years experience working with Healthcare Risk Management programs preferred. Vocational training in legal secretarial or paralegal credentials or work experience.
We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes:
- Health benefits
- Life insurance
- Long-term disability coverage
- Healthcare spending accounts
- Retirement plan
- Paid time off
- Pet Insurance
- Tuition reimbursement
- Employee assistance program
- Wellness program
- On-site housing for selected positions and more
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