Patient relations - risk management specialist

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:

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

License, Certification, Education or Experience:

REQUIRED for the position:

• Associate’s 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:

• Bachelor’s 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