Job DescriptionLocation: Chicago, ILHospital: Rush University Medical CenterDepartment: RUSH Procurement and MDMWork Type: Full Time (Total FTE between 0.9 and 1.0)Shift: Shift 1Work Schedule: 8 Hr (8:00:00 AM - 5:00:00 PM)Rush offers exceptional rewards and benefits learn more at our Rush benefits page .Summary:In conjunction with the Senior Associate General Counsel and members of the Office of Risk and Claims Management (ORCM), this position is responsible for assisting in the oversight and management of professional and general liability suits and claims for Rush University Medical Center (RUMC) and Rush Oak Park Hospital (ROPH), as well as oversight of the TPA for all OCIP-related claims. It partners with Clinical Risk Managers on all Potentially Compensable Events (PCEs), which evolve into claims, as well as with Legal Affairs, Patient Relations, Corporate Finance, Risk Management and Capital Projects, as needed. It is also responsible for all CMS Section 111 reporting for the ORCM. This individual exemplifies the RUSH mission, vision and values and acts in accordance with RUSH policies and procedures.Other information: Bachelor’s degree required. 5 years’ experience as a litigation paralegal working with general liability and/or medical malpractice claims is strongly desired. Knowledge of medical terminology, Cook County local rules and litigation procedure is required. Experience with a RMIS system and/or claims management systems is strongly desired. Clear and concise verbal and written communication skills. Organizational and analytical skills required. Experience meeting deadlines required. Competent in data analysis techniques. Experience working collaboratively and independently. An approachable, positive, energetic, and proactive nature. Committed to accountability, process improvement, and process excellence.Responsibilities:LITIGATION AND CLAIMS MANAGEMENT
Assists in maintaining all litigation and claims data in the Risk Management Information System (RIMS).
Daily maintenance and responsibility of claims files, including conducting independent evaluations of claims, communicating with outside counsel and insureds, and assisting with pre-suit investigations.
Verifies employment status and current whereabouts of defendants or potential defendants.
In conjunction with outside counsel, executes a detailed review and analysis of the plaintiff’s medical records.
Verifies and obtains information to assist outside counsel in answering written discovery in general and professional liability claims.
In conjunction with outside counsel, retains experts as soon as possible in complex matters, to help provide increased understanding of potential issues.
Escalates significant events that may have financial impact or otherwise affect the outcome of the matter.
Participates in quarterly claims meetings and establishing plan for continued work-up of all matters.
Prepares formal written status reports to various internal and external business partners on assigned claims, including an evaluation of liability, damages, settlement value, and resolution plan.
In conjunction with Litigation and Claims Counsel, participates in settlement discussions and mediation, as necessary.
Attends and monitors trial and reports trial activity to Senior Associate General Counsel, Chief Risk Officer/Deputy General Counsel, General Counsel, and re-insurers, as requested.
Notifies re-insurers of selected claims according to established criteria and provides file updates pursuant to reporting guidelines.
Assists with monitoring and reviewing of billing for outside defense counsel.
Formulates Closed Claim Reports highlighting “lessons learned” through the litigation process.
Shares claim findings and outcomes with Clinical Risk Management, departmental leadership, and Quality Improvement.
Partners with Clinical Risk Management to promote loss prevention measures and in conducting investigations on Potentially Compensable Events (“PCE”).
Provides oversight to the TPA on all OCIP-related claims, including, but not limited to, reviewing claims files, participating in claims meetings, and providing authority when necessary, in addition to keeping Capital Projects up to date on OCIP claims.
Assists with the management and/or response to patient/family/visitor complaints that request compensation and/or involve attorney representation.
Facilitates legal holds on records and evidence when needed.
Assists Senior Associate General Counsel with reporting of professional and general liability claims via the loss run.
Coordinates ongoing education provided to medical staff, house staff, advanced practice providers and nursing, as necessary.
Responds to Claims History Requests of providers and external facilities who are credentialing or recredentialing.
Conducts Westlaw and JVR research projects, as necessary.
CONDUCT CMS SECTION 111 REPORTING
Updates/maintains a working list of matters to be reported by RUMC/ROPH during the quarterly reporting period. Maintains historical list of all settlements/verdicts with a Medicare beneficiary reported to CMS by RUMC/ROPH.
Reports required information in MMSEA processing software within the assigned 7-day reporting time period for each quarter. Maintains paper copies of final “as reported” file data and submission receipt and obtains/maintains copies of MMSEA data submission fields, beneficiary Query response, and CMS submission confirmation for file pursuant to the Office of Risk Management Closed File Policy.
Updates Required Reporting Entity (RRE) password on the Section 111 Secure Website in accordance with website regulations (every 60 days) and maintain both electronic and paper record of such information.
Coordinates yearly update of RRE Profile Report, review accuracy of profile information, arrange for signature by RUMC “Authorized Representative” and submit to EDI representative. Maintains paper and electronic file copies of submitted yearly Profile Reports and confirmation of receipt by EDI representative.
Coordinates Medicare Secondary Recovery Reporting Portal (MSPRP) requests for conditional and final payoff letters in situations where settlement with pro se Medicare Beneficiary occurs.
Tracks legal and regulatory developments pertaining to Section 111 Reporting and Medicare Secondary Payer Recovery Portal.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.Position ParalegalLocation US:IL:ChicagoReq ID 14253