Angela Puckett
Billings
Summary
Experienced Director of Risk Management and Patient Relations with a strong background in healthcare risk mitigation, claims management, and patient safety. Proven track record of leadership resulting in a significant reduction in professional and general liability claims, improved organizational efficiency. Adept in negotiation, early claim resolution, resource management, implementing effective risk strategies to drive continuous improvement. Committed to leveraging expertise to contribute to the success of future roles in the industry.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Director of Risk Management and Patient Relations
Billings Clinic
07.2020 - Current
- Direct and oversee all aspects of Risk Management programs, ensuring optimal risk mitigation
- Manage system self insured captive insurance company for professional and general liability insurance, achieving measurable successes in claim resolutions
- Manage and set claim reserves based on knowledge and experience related to type of claim, severity, and other relevant factors that may influence the claim
- Manage system wide insurance program, serving as liaison with insurance companies, securing comprehensive coverage for all stakeholders
- Serve as authority in settlement negotiations in mediations and early resolutions, achieving excellent settlement outcomes
- Collaborate with outside legal counsel, experts, excess insurance counsel and others, ensuring optimal claim strategy
- Implement risk mitigation strategies, reducing liability claims by 20%, enhancing patient safety and organizational efficiency
- Lead and develop risk programs, significantly reducing organizational risk
- Work closely with Patient Safety and Compliance teams to identify risks and develop actionable plans, improving service quality
- Review and negotiate contracts to secure appropriate coverage, minimizing financial risk for the clinic
Risk and Claims Manager
Billings Clinic Hospital
06.2015 - 06.2020
- Manage professional and general liability claims for a complex multi-system healthcare facility
- Complete medical record reviews and analyze care from legal/risk perspective
- Evaluate patient care based on evidence-based practice and standard of care
- Compose letters to patients, families, and legal counsel on risk related issues
- Work with insurance companies on reimbursement and medical coverage issues
- Facilitate and participate in patient and family discussions
- Act as patient advocate - receive, investigate, and resolve patient concerns
- Initiate early claim resolution strategies as appropriate
- Represent organization at Montana Medical Legal Panel
- Analyze patient damages and recommend settlement value based on risk exposure
- Negotiate professional and general liability settlements
- Authorize patient account adjustments based on assessment of risk exposure
- Develop and maintain risk management profiles on physician and ensure integration of information into credentialing process
- Provide direction and consultation services to physicians and staff as necessary in connection with malpractice and medical legal matters
Manager Care Coordination
Benefis Health System
08.2013 - 06.2015
- Manage Utilization Review, Clinical Denials, Clinical Documentation (CDI) programs
- Provide leadership, oversight for eighteen (18) employees
- Restructure department programs to improve effectiveness and efficiency of case management functions
- Work collaboratively with coding management and staff to implement CDI program
- Lead and chair Utilization Review Committee
- Actively work with insurance company representatives on Utilization Review and insurance denial matters
- Review and analyze insurance denials through medical record review and analysis
- Apply evidence-based practice as justification for medical necessity
- Facilitate peer to peer reviews with treating provider and medical director of insurance company in effort to obtain coverage for hospitalization
- Work directly with Revenue Cycle team on payer and insurance denial issues
Risk Management Clinical Coordinator
Benefis Health System
01.2006 - 08.2013
- Review and investigate incident reports using the Midas reporting system
- Complete medical record reviews and analyze care from legal/risk perspective
- Evaluate patient care based on evidence-based practice and standard of care
- Coordinate and lead adverse event and disclosure discussions
- Develop and implement programs and policies and procedures
- Participate in medical peer review with Chief Medical Officer and Medical Staff
- Work with legal counsel on general and professional liability matters
- Actively participate in assessment and evaluation of liability insurance coverage and provide confidential loss analysis, activity, and status reports to administrative team
Education
Bachelor of Science - Nursing
Montana State University
Bozeman, MT12.1997
Associate of Science - Paralegal Studies
College of Great Falls
Great Falls, MT05.1993
Skills
- Managerial
- Leadership
- Negotiation
- Analytical
- Critical thinking
- Communication
- Writing
- Grammar
- Goal oriented
- Resourceful
- Creative
- Intuitive
- Proactive
- Precise
- Customer service
- Caring
- Compassionate
- Operational risk management
- Insurance management
- Risk reporting
- Risk mitigation strategies
- Willing to learn
- Teamwork
- Teamwork and collaboration
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking Abilities
- Reliability
- Excellent communication
- Organizational skills
- Active listening
- Team collaboration
- Effective communication
- Adaptability and flexibility
- Decision-making
- Team building leadership
- Planning and coordination
- Relationship building and management
- Prioritizing and planning
- Customer relationship development
- Proactive and focused
- Self motivation
- Interpersonal skills
- Client relationship management
- Analytical thinking
- Conflict resolution
- Goal setting
- Risk assessment
- Professionalism
- Staff management
- Interpersonal communication
- Strategic planning
- Continuous improvement
- Adaptability
- Written communication
- Quality assurance
- Data analysis
- Risk management
- Professional demeanor
- Problem-solving aptitude
Personal Information
Title: RN, BSN, CPHRM
Certification
Certified Professional Healthcare Risk Management (CPHRM), ASHRM
Timeline
Director of Risk Management and Patient Relations
Billings Clinic
07.2020 - Current
Risk and Claims Manager
Billings Clinic Hospital
06.2015 - 06.2020
Manager Care Coordination
Benefis Health System
08.2013 - 06.2015
Risk Management Clinical Coordinator
Benefis Health System
01.2006 - 08.2013
Associate of Science - Paralegal Studies
College of Great Falls
Bachelor of Science - Nursing
Montana State University
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