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Risk Analyst

Salary: N/A

DEFINITION: Under general direction, performs professional level analytical work as part of a comprehensive risk management program in one of four areas of assignment: HIPPA Compliance, Worker's Compensation, General Liability/Medical Malpractice, or the Back-To-Work Program; and performs other duties as required.

EXAMPLES OF DUTIES:

* HIPPA Compliance

1. Chairs the County's HIPAA Committees, which are charged with the responsibility for monitoring regulatory requirements, developing Countywide HIPAA privacy and security programs, and implementing appropriate strategies to promote compliance.
2. Acts as a resource for departments affected by HIPAA and provides education on the requirements to perform actions such as an initial inventory, gap analyses, and risk assessments to determine appropriate privacy and security-related organizational policies and procedures; conducts studies of current information and data flow of protected health information within and between affected County departments and programs including exchanges with contract providers and vendors; coordinates with the County Administrator's Office, County Counsel, and other department heads and departmental program managers to develop and implement the County's HIPAA compliance program and address various compliance issues.
3. Coordinates with County Counsel and impacted departments to develop all legally required documents and forms, including, but not limited to: Notice of Privacy Practices, Authorization, Request to Access/Amend Record; Request to Restrict Access, and Denial of Access or Amendment; oversees development and implementation of business associate agreements to ensure all privacy concerns, requirements, and responsibilities are addressed.
4. Develops and implements privacy awareness training relevant to HIPAA compliance issues for all affected County employees, including documenting ongoing HIPAA-related training; coordinates with Human Resources, County Counsel, and County departments to establish appropriate sanctions, as required by HIPAA, for employees who fail to comply with the County's HIPAA policies and procedures.
5. Establishes and administers formal processes for receiving, investigating, taking action on, and documenting all complaints related to the County's HIPAA policies and procedures in coordination with other County managers, County Counsel, and Human Resources; cooperates with the federal Department of Health and Human Services Office for Civil Rights and other officials in any compliance reviews or investigations of alleged breaches of privacy policy and procedures; prepares and submits written reports to the Board of Supervisors and County Administrator regarding the status of the County's medical privacy and security program.
6. Receives and responds to complaints regarding alleged breaches of the County's HIPAA policies and procedures; ensures complaints are acted upon in a timely manner; coordinates and conducts investigations into complaints; recommends appropriate corrective measures, including sanctions if justified by the results of the investigation.
7. Maintains current knowledge of applicable standards and revises the HIPAA compliance program as necessary; informs County departments of new HIPAA legislation and regulations; on an on-going basis, maintains accessible documentation regarding HIPAA compliance for departmental use; conducts medical privacy audits of departments to ensure continued compliance with all applicable federal, state and local legislation; serves as an internal resource to all County departments for HIPAA-related matters; prepares a summary report of HIPAA compliance program activities for distribution to County departments.

* Workers' Compensation

1. Investigates claims to determine compensability by interviewing claimants, witnesses, and other individuals; assigns independent adjusters to manage claims; documents file activity in the claims management system; develops and implements a course of action to resolve claims; obtains pertinent information to determine compensability or extent of injuries, including police reports, internal accident investigation forms, and medical reports.
2. Manages injured workers' medical treatment claims; obtains work site evaluations to prevent further injury and to assist in returning the employee to work; coordinates the claimant's return to work with the Back-To-Work Counselor and department representative; manages services of vocational rehabilitation vendors who provide retraining to disabled employees.
3. Obtains evidence in contested and/or litigated claims to assist County Counsel or outside attorneys to defend claim and to prepare for trial; prepares for and represents the County at Worker's Compensation Appeals Board (WCAB) and other administrative bodies; may act as an expert witness for the County.
4. Attends review team meetings to evaluate individual cases; communicates with assigned departments on specific claims and during scheduled departmental meetings; establishes, reviews, and adjusts financial reserves of claims; negotiates and settles claims within established authority and/or negotiates and recommends settlement of claims exceeding established authority; reviews invoices and authorizes payments for indemnity, medical, and other charges; investigates and pursues viable third party subrogation; prepares related reports, statistics, and correspondence necessary to manage the claims process.
5. Reviews and determines the significance of new statutes, regulations, and reported cases to determine their significance to the County; refers departmental accident reports, duty assignments, job descriptions, and safety practices to the County Safety Officer for possible corrective action(s).
6. Assists the Risk Analyst, Supervising in training and supervision of paraprofessional staff.

* General Liability/Medical Malpractice

1. Investigates and evaluates claims to determine liability; assigns and directs independent adjusters to investigate claims, when appropriate; documents file activity in the claims management system; investigates claims by interviewing claimants, witnesses, and other individuals; obtains police reports, internal accident investigation forms, medical reports, photographs, and other pertinent materials; develops and implements a course of action to resolve claims.
2. Obtains evidence in contested and/or litigated claims to assist County Counsel or outside attorneys to defend claim and to prepare for trial; prepares for and represents the County at court appearances and other administrative bodies; may act as an expert witness for the County.
3. Attends review team meetings to evaluate individual cases; establishes, reviews, and adjusts financial reserves of claims; negotiates and settles claims within established authority and/or negotiates and recommends settlement of claims exceeding established authority; investigates and pursues viable third parties responsible for damage; tenders indemnification and defense to third parties pursuant to contractual agreement; prepares related reports, statistics, and correspondence necessary to manage the claims process.
4. Reviews and determines the significance of new statutes, regulations, and reported cases to determine their significance to the County; refers departmental accident reports, duty assignments, job descriptions, and safety practices to the County Safety Officer for possible corrective action(s).
5. Assists the Risk Analyst, Supervising in training and supervision of paraprofessional staff.

* Back-To-Work

1. Coordinates with the Workers' Compensation unit to "capture" new claimants' information so they can be offered an appropriate Back-To-Work position; monitors ongoing Back-To-Work placements; develops and implements a course of action to ensure effective placements; obtains and analyzes pertinent information to assist in determining appropriate placements.
2. Interacts with all County departments, by training departmental coordinators and department management on the benefits of the Back-To-Work program.
3. Promotes the Back-To-Work program Countywide to ensure maximum participation.
4. Participates in the annual Back-To-Work Conference for all public and private entities that have Back-To-Work programs.
5. Reviews and determines the significance of new statutes, regulations, and reported cases to determine their significance to the County; refers departmental accident reports, duty assignments, job descriptions, and safety practices to the County Safety Officer for possible corrective action(s).
6. Assists the Risk Analyst, Supervising in training and supervision of paraprofessional staff.

EMPLOYMENT STANDARDS FOR HIPPA COMPLIANCE POSITION:

1. Two years of management or program administration experience with significant responsibility for developing and implementing policies and procedures that ensure compliance with federal, state, or local laws and regulations; or,
2. a combination of training, education, and experience that is equivalent to the employment standard listed above ant that provides the required knowledge and abilities.

Additional Qualifications: Possession of a valid California Class C Driver's License.

Knowledge of: techniques of administrative and organizational systems analysis; principles and practices of project planning, monitoring, and evaluation; methods of research including the use of automated systems; effective interviewing and investigation techniques; computer software, including word processing, spreadsheet, database programs; data administration including the categorizing, storing, and dissemination of information; standard English usage and grammar.

Ability to: read, learn, understand, and interpret the Health Insurance Portability and Accountability Act of 1996; learn other relevant information privacy laws related to access and release of protected medical information; research, analyze, and apply legislation and legal precedents to resolve issues; communicate effectively both verbally and in writing; make independent decisions; analyze situations and take appropriate action; represent the County in an effective and professional manner; establish and maintain effective working relationships with the public, other departments and agencies, boards and commissions, public officials, and community groups; organize own and others' work on multiple projects while meeting deadlines; influence others over whom one has little or no authority; maintain confidentiality of information.

Desirable Qualifications: Knowledge of HIPAA-related rules and regulations.

EMPLOYMENT STANDARDS FOR ALL OTHER POSITIONS:

1. Two years of experience in handling employee or third party claims as an adjuster, examiner, or equivalent for a self-insured public entity, equivalent private sector employer, third party administrator, or insurance carrier, preferably related to the area of assignment; or,
2. two years of experience performing duties equivalent to a Claims Assistant (preferably performing duties relating to the area of assignment) with Santa Barbara County; or,
3. a combination of training, education, and experience equivalent to one of the employment standards listed above that provides the required knowledge and abilities.

Additional Qualifications: Possession of a valid California Class C Driver's License.

Note: Possession of, or ability to obtain within one year of employment, the California Self-Insured Administrator's Certificate is required for the assignment to Workers' Compensation.

Knowledge of: Federal and State legal statutes relating to risk management and loss control programs; the principles and practices of loss control programs; medical and technical terminology used in industrial injury/illness cases and in the insurance industry; all relating to the area of assignment.

Ability to: analyze claims in accordance with applicable laws and County procedures and policies; present arguments and statements of fact in written and oral forms; exercise independent judgment in resolving claims; assist in training and reviewing the work of staff; establish and maintain working relationships with County managers, employees, attorneys, medical personnel, and other individuals involved in the claims process; read, understand, and evaluate complex reports, laws, and case histories; evaluate and negotiate settlements; and prepare oral and written reports.

Desirable Qualifications: Two years experience handling worker's compensation claims as an adjuster or examiner is desirable for the Worker's Compensation and Back-To-Work assignments; two years of experience handling general liability and/or medical malpractice claims as an adjuster or examiner is desirable for the General Liability/Medical Malpractice assignment. Completion of Insurance Education Association (IEA) or Chartered Property Casualty Underwriter (CPCU) courses and/or possession of professional certifications, such as Associate In Claims (AIC), Associate in Risk Management (ARM), or certification of completion in training in the California Fair Claims Handling Act; completion of Worker's Compensation Claims Designation; multifunctional experience in claims and safety are desirable for all assignments.

 



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