525 w. Brown Rd Mesa, AZ 85201 United States
The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. Our team has come together with the common goal: Make health care easier, so life can be better. The future of health care starts here. If you're ready to change lives, we want to hear from you. Apply today. If you like a challenge, if you like a variety, if you like a constant learning environment, this position might be for YOU! Join us and use your critical thinking skills and medical knowledge to work for one of the top employers in Healthcare! Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life. Job Summary This position supports the Litigation and Claims Management function of Banner Healths self-insurance program. This position compiles, reviews, analyzes, and summarizes documentation and evidence necessary to investigate claims not in litigation and assists in compiling necessary documents and other evidence in litigated matters including medical professional liability, employment liability, and general liability matters. This position assists Claims Directors and outside counsel with subpoenas, discovery, litigation holds, and coordinating discovery, witnesses and non-suit depositions. Independently performs a variety of complex legal and administrative duties with a high degree of skill and accuracy. Works both independently and under supervision to collaborate with outside defense counsel and Claims Directors to draft responses, collect, collate and summarize information/data with little or no supervision. Essential Functions Collects, reviews, analyzes, and summarizes documentation and evidence including, but not limited to, medical records, billing statements, policies and procedures, staff schedules, hospital census sheets, information related to equipment issues, and lien information pertaining to claims, pre-litigation, and litigated matters for both civil and criminal claims and/or lawsuits. Responds to subpoenas and requests for records which are related to civil or criminal matters. Coordinates witnesses and resources as appropriate for non-suit depositions. Assists with scheduling and attending the site visits as requested or when there may be outside counsel or consultants viewing the medical records, equipment, or the facility. Identifies applicable insurance policies, and determines employment and/or contractual status of relevant parties and/or entities. Identifies relevant physician-related and non-physician related contracts. Provides information to Risk Management Department personnel regarding whether specific parties and/or entities have system contracts; secures copies of applicable contracts, employment status of personnel and curriculum vitae of experts. Ensures compliance with company policies and procedures and applicable state and federal rules and regulations, including Business Associate Agreements, Stark and HIPAA. Identifies key players and key search terms for Legal Hold purposes. Researches and reviews the appropriate court venue docket in state and/or federal court as appropriate. Reviews, analyzes, and oversees the drafting of responses to preservation requests and legal holds. At the direction of legal counsel, issues legal holds, monitors compliance therewith, and issues releases upon matter resolution. Serves as Risk Managements liaison to other functions and other business units on issues relating to document and discovery management. Provides consultation and leadership in relation to electronic discovery (e-discovery) efforts involving a wide range of computer software databases. Works with IT and other departments to coordinate the collection processes, and capture available and responsive Electronically Stored Information data. Maintains extensive familiarity with documents and issues involving claims, pre-litigation, and litigation matters in order to provide input and assist in all aspects of the collection, completion and distribution of non-litigation and litigation discovery documents, applicable billing statements and medical records. Organizes and tracks submitted information and recommends collection of additional information in order to facilitate the drafting of discovery responses. Procures and provides the Risk Management file and other pertinent documentation to Claims Directors and/or outside defense counsel, and assists in preparation of discovery responses. Responsible for obtaining and entering data into Risk Management Information System (RMIS) file. Saves and maintains documents in RMIS on claims, pre-litigation and litigation matters to ensure an efficient, organized, and document-intensive case file is current and well maintained. Responsible for monitoring such data in order to comply with deadlines for meeting Section 111 of the Medicare, Medicaid, SCHIP Extension Act (MMSEA) reporting requirements in relation to claimants and others releasing medicals. Monitors compliance with Medicare Secondary Payer (MSP) Act requirements including recording and monitoring pertinent CMS information in RMIS to ensure compliance with regulations and reporting. Maintains litigation calendar, to include subpoena due dates; deposition dates, and appearance dates, as required. Maintains library of various documents including archived and active policies and procedures, Medical Staff Bylaws and Rules and Regulations, employee rosters, curriculum vitae of consultants/experts, and Settlement Releases. Opens claim file into the RMIS database when requested. Assists in the initial review and assessment of claims, pre-litigation and litigation matters. Requests and reviews pertinent information to support damage claims, such as lien information. Submits necessary information to consultant/expert for review. Collaborates with Claims Directors regarding disposition of claim. Drafts appropriate Settlement Release documents, to include appropriate MMSEA and MSP language, and National Practitioner Data Bank Reports. Minimum Qualifications: Must possess a strong knowledge of healthcare, litigation, business and/ or law as normally obtained through the completion of a bachelors degree in a related field. Must possess or obtain active Notary Public commission within 90 days of hire. Must possess strong organizational and analytical abilities with ability to interpret internal policies and procedures, medical information, and complex state and federal rules and regulations and summarize such information in written form. Must be able to prioritize multiple projects, coordinate large volumes of data, track and meet court-imposed deadlines, with limited supervision. Maintains strict confidentiality. Requires effective oral and written communication skills and the ability to work well as a part of a team. Preferred Qualifications: Registered nurse with active license with clinical experience is preferred.In-house claims or risk management experience.