Patient Relations - Risk Management Specialist in Kirkland, Washington at EvergreenHealth

Wage Range: $26.16 - $41.82 per hour

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary:
Supports the delivery of exceptional patient-centered care by managing complaints and grievances with empathy, facilitating service recovery, and ensuring concerns are resolved promptly and in compliance with regulatory standards. Serves as a liaison between patients, families, care teams, and leadership. Utilizes trust-building and strong communication skills to support risk management efforts, such as case review and claims coordination. Identifies trends and seeks ways to improve processes and reduce concerns.

Primary Duties:

1. Ensures compliance with CMS and organizational requirements for grievance management, including meeting established timelines for investigation and response.
2. Receives, documents, and manages patient complaints and grievances in accordance with regulatory requirements and organizational policies.
3. Assists with intake, tracking, routing, and documentation of claims, potential claims, and other matters received via calls, emails and patient inquiries.
4. Identifies potential risk or liability concerns within complaints and escalates appropriately.
5. Ensures and supports the timely acknowledgment of concerns and grievances.
6. Supports the gathering of records and documentation requests for claims and legal review.
7. Supports and collaborates with Patient Relations and Risk Management on case tracking, follow-up, and reporting needs.
8. In collaboration with clinical and operational staff, coordinates and conducts investigations, including medical record review.
9. Provides customer service, service recovery, and supportive patient communication, including follow-up and resolution.
10. Coordinates with departments and leadership to resolve concerns and ensure timely closure.
11. Maintains organized and accurate records of claim-related activities, including documentation in complaint/grievance and risk management systems.
12. Performs other duties as assigned.

License, Certification, Education or Experience:

REQUIRED for the position:

• Associates degree in healthcare related field or equivalent combination of education and experience
• 1 year of experience in patient relations, risk management, healthcare operations, or related field
• Experience managing complaints, customer service issues, or service recovery
• Strong written and verbal communication skills
• Ability to manage sensitive and confidential information

DESIRED for the position:

• Bachelors degree in healthcare administration, nursing, social work, public health, or related field
• 3 years of experience in patient relations, risk management, or healthcare operations
• Experience with grievance investigations and regulatory requirements (e.g., CMS Conditions of Participation)
• Exposure to claims management or legal case coordination
• Experience working in a clinical or patient care environment
• Familiarity with complaint, risk, or incident healthcare management systems

Benefit Information:
Choices that care for you and your family

At EvergreenHealth, we appreciate our employees commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans 457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits
• Cafeteria & Gift Shop Discount

View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.

Kirkland Employee Benefits | Kirkland, WA | EvergreenHealth