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 also responsible for conducting investigations and submitting patient belonging claims, ensuring compliance with regulatory standards and internal policies.
Essential Job Statements
Clerical Staffing CoordinationDevelops office guidelines and processes, monitors and revises them as needed. Maintains staffing and on-call calendars within the department. Triages and assigns incoming calls and emails.Operations Support for the DepartmentCoordinates and supports risk management initiatives across departments. Assists with risk assessments and developing mitigation strategies. Monitors compliance with risk management policies and procedures. Maintains records of incidents, insurance investigations, claims, and risk reports. Prepares risk analysis reports for leadership. Supports training programs related to risk awareness and compliance. Collaborates with legal, security, and operations teams to review processes and identify potential liabilities. Stays updated on relevant laws, regulations, and best practices in risk management. Leads the process of managing investigations and submission of insurance claims. Participates in audits and safety improvements.Claim InvestigationsCoordinates and manages investigations of belonging and fall claims, including case assignment. Reviews claims for accuracy and completeness. Interviews staff and analyzes medical records and provider documentation to validate claims. Collaborates with providers, patients, legal teams, and regulatory agencies. Prepares detailed investigative reports and summaries. Ensures compliance with HIPAA, CMS, and other healthcare regulations. Maintains accurate documentation. Monitors trends in claim discrepancies and recommends process improvements. Educates staff on investigative procedures and compliance standards. Assists in audits and regulatory reviews.Administrative SupportHandles mailings, processes recall notices, maintains the department SharePoint site, and creates/edits documents, forms, and presentations.Miscellaneous ResponsibilitiesPerforms other duties as assigned, participates in special projects, supports team members, and provides education to units/departments as needed.Qualifications
Education: Bachelor's degree in healthcare administration, Business, Project Management, or related field from an accredited program.
Experience: Minimum of two (2) years of administrative experience in an office setting, with knowledge of insurance or medical claim investigation and submission. Proficiency in Microsoft Office and Adobe Pro.
Skills: Customer service experience, ability to manage multiple investigations/projects, meet deadlines, strong communication, analytical, critical thinking, discretion, independence, organizational skills, and project management.
Working Conditions and Physical Requirements
Includes periods of high stress, exposure to verbal abuse, noise, bright lights, hazardous substances, and body fluids. Must exercise universal precautions and use PPE. Physical demands include lifting, carrying, pushing, pulling, and other physical activities. The work environment involves sitting, standing, and walking. Must have strong sensory and emotional resilience to handle a fast-paced environment and frequent change.
Individuals must adhere to infection control policies and safety protocols.
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