Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. Kepro is seeking resumes for a highly experienced professional.
RN Expert Claims Reviewer/Project Support Specialist (Remote Opportunity)Summary Description
The RN Expert Claims Reviewer/Project Support Specialist will work on several contract tasks and deliverables, including educational webinars and other work related to health center program improvement and patient safety. The candidate will analyze claims, prepare claim management/risk management reports and medical chronologies, collaborate with the Data Analytics team in preparing various data-driven reports, and perform other duties and/or special projects as required or assigned.Accountabilities
The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.
- Assist in the development, coordination, and implementation of health center educational webinars, the target audience for which includes clinical providers, healthcare facilities, administrative and executive staff. Topics include, but are not limited to, credentialing and privileging guidance, obstetric education, prenatal education, hospitalization/referral/test tracking policies/procedures, claims management processes, peer review, medication safety, and risk management program basics.
- Assist with a variety of project requests from contractor, which are generally related to improving the delivery of high quality/safe patient care and management and/or analysis of claims activity.
- Prepare pre-litigation risk management reports which define claim specific risk management recommendations designed to promote patient safety, avert future risk, and improve the quality of care. Upload or use claims database to enter completed reports.
- Prepare pre-litigation claim management reports which demonstrate an understanding of the claim. (i.e., identify and define relevant medical-legal liability issues affecting defensibility; recognize and discuss extenuating and mitigating circumstances; provide meaningful instruction for claim management, and assign an accurate loss reserve using venue-based statistics and claim trend reports).
- Prepare detailed medical chronologies as relevant to potential exposure, identify defendants for review from claim documents, review and organize medical records and legal documents, and use claims database to enter basic applicable diagnosis and risk management codes and upload/enter completed chronology.
- Assist with completion of paid case chronology reports.
- Participate as needed in the annual deeming/redeeming application review process.
- Collaborate with the data analytics team in developing and completing various data reports.
- Support corporate and contract goals: complete other related tasks as required or as assigned, assist/collaborate with other team members as needed on projects and maintain a positive and proactive mindset to participate in the identification of potential internal process improvement.
- Demonstrate a willingness to cross train and perform duties of other contracts within Kepro if needed, to provide a flexible workforce to meet client/customer needs.
Knowledge, Skills, Abilities
- BSN, advanced degree in health related, business, or legal field preferred. ADN combined with BA/BS/MA/MS also considered.
- Active, unencumbered RN license.
- Excellent oral and written communications skills.
- Strong analytical and interpretive skills.
- Strong organizational and decision-making skills.
- Computer proficiency in Microsoft Word, Excel, Power Point, Sharepoint, video conferencing technology and other software programs operating in a Windows environment.
Mental And Physical Requirements
- Minimum of 5-10 years of RN clinical experience required, preferably across at least two of a variety of specialties, including medical-surgical, intensive care, obstetric, gynecologic, emergency, urgent care, medical or OB physician office setting, and/or pediatrics.
- Previous experience in a risk management setting, legal nurse, healthcare compliance, or healthcare facility management preferred.
- Previous experience with credentialing, privileging, FTCA/health care policy writing preferred.
- Previous experience with formal report writing preferred.
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 will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.
Kepro offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please.
Visit our website at for more information on the Kepro Family of Companies.EOE AA M/F/Vet/Disability
Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.