READ JOB DESCRIPTION CAREFULLY - EXPERIENCE REQUIRED
BASIC NATURE OF POSITION:
The HR Risk Specialist is responsible for proactively identifying potential risks within The Wellness Plan Medical Centers (TWPMC) operations and services, focusing on areas within the HRSA-approved scope of project including areas such as referrals, diagnostics, patient safety and medication management.
EDUCATION EXPERIENCE:
Formal education required:
- Bachelor’s degree from an accredited institution in human resources, healthcare administration or related field and/or equivalent years of experience.
- Additional education or experience in healthcare risk management.
Experience/skills/ability required (number of years and type, if applicable):
- 2-years of management experience in human resources management, risk management, training, compensation and benefits, employment and employee relations
- 2-years’ experience in Corporate Compliance, Risk Management and Claims Management
- 2-years’ experience in healthcare or general risk management or healthcare administration, paralegal, or experience in property and casualty claims and insurance program management
- 3-years’ experience with employee benefits (FMLA, ADA, 401(k), medical/dental, STD/LTD, Life, etc.)
- 3-years’ experience with federal, state and local labor laws and regulations
- 2-years' experience in a Community Health Center
- Knowledge and experience working with Uniform Data Systems (UDS), Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA)
- Thorough knowledge of healthcare laws, state and federal regulations and standards, including COBRA, ERISA, OSHA, HIPAA and Worker’s Compensation
- Knowledgeable of laws at the state and federal level that govern compliance, human resources, employment relations and benefits
- Knowledgeable of FTCA and HRSA policies and practices as well as Community Health Center policies and practices
- Strong computer skills with HRIS, spreadsheets, word processing, presentations and other database(s)
Further formal education which is not required but which may be desirable:
- Master’s degree in human resources, healthcare administration or related field
- Paralegal experience
Additional knowledge, skills and abilities which are not required but which may be desirable:
- Familiar with Federal Tort Claims Act (FTCA), Risk Management, Claims Management and Guaranteed Asset Protection (GAP) Insurance
- Familiar with Federally Qualified Health Center (FQHC) related policies and procedures
- Experience with electronic medical records
- Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS) measures
- Familiar with Patient-Centered Medical Home (PCMH) standards
PRIMARY RESPONSIBILITIES:
- Managing and analyzing event reports, patient grievances and complaints, including conducting thorough investigations of serious incidents, root cause analyses and implementing corrective actions.
- Developing and implementing a comprehensive annual risk management training plan for all employees, covering areas like infection control, HIPAA compliance and specific clinical procedures.
- Creating and updating policies and procedures related to risk management, ensuring they align with FTCA requirements and best practices.
- Ensure the TWPMC complies with all FTCA requirements, including proper documentation, reporting and claims management.
- Preparing and submitting required risk management reports to the Chief Compliance Officer and the Leadership Team, including analysis of adverse events, trends and progress towards risk management goals.
- Collaborate closely with staff, leadership and potentially external stakeholders to promote a culture of safety and risk awareness.
- Stays up-to-date on state and federal regulations concerning insurance and other employee benefits
- Demonstrates broad knowledge of the variety and structure of retirement plans, from pensions to 401(k)’s to IRAs and Roth IRA’s
- Possesses knowledge of the laws surrounding benefits and compensation for employers
- Demonstrates broad knowledge of different health insurance plans, including HMOs and PPOs
- Exhibits solid organizational skills
- Communicates clearly and effectively
- Is able to translate legal, medical and insurance-related jargon into plain language for clarification purposes
- Responds to benefits inquiries from managers and employees on plan provisions, benefits enrollments, status changes and other general inquiries
- Processes and administers all leave-of-absence requests and disability paperwork: medical, personal, disability and FMLA
- Effectively interprets FMLA and ADA implications as they relate to leaves of absences/disabilities
- Responds to 401(k) inquiries from managers and employees relating to enrollments, plan changes and contribution amounts.
- Assists with new-hire orientations and employee exit interview
- Assists with the open enrollment process
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Environmentally controlled medical office environment
- Possible exposure to patients with illness and or infections.
- Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public.
DISCLAIMER:
"This description is intended to describe the type and level of work being performed by a person assigned to this job. It is not an exhaustive list of all duties and responsibilities required by a person so classified.”
Job Type: Full-time
Pay: $65,000.00 - $70,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
