The Healthcare Insurance Reciprocal of Canada (HIROC) is a trusted healthcare safety advisor, committed to offering a full spectrum of insurance, risk and claims management products and support.

HIROC knows healthcare as it’s the largest not-for-profit healthcare liability insurer in the country, with over 700+ healthcare organizations part of the Reciprocal. Combined with sage counsel and risk management solutions, HIROC works with its partners to increase safety.

As a Reciprocal, HIROC is governed by its Subscribers and remains an innovative, agile and proactive partner. Since its inception in 1987, the not-for-profit has returned over $200 million to the healthcare system.

HIROC’s thirty-plus years of data is combined with its extensive experience to advise and share learnings, all with the goal of scaling knowledge and increasing safety across Canada’s healthcare system.

One common thread running through HIROC’s culture is the feeling of being part of something unique: partnering to create the safest healthcare system – HIROC’s vision.

Each employee has the opportunity to find their calling and help build a stronger organization designed to meet the needs of its Subscribers. As a Top 100 GTA Employer eight years running, HIROC employees are empowered to find solutions and create amazing experiences in service to its Subscribers.

Join us and be part of the team working to make a difference.

Summary

The Coding Specialist, reporting directly to the Lead Risk at HIROC, plays a pivotal role in the organization's analytics development and research initiatives. Responsible for reviewing liability and property claims, the specialist identifies clinical, risk, insurance, and incident-related details to ensure accurate claim recording consistent with HIROC’s coding methodology and framework. Utilizing ICD-10-CA, CCI, and other coding standards, they assign initial codes, contributing to the consistency of clinical and patient safety data capture. Additionally, the specialist will lead regular coding audits, arrange for meetings, and provide education, fostering a culture of continuous improvement. The role is responsible for data integrity, liaising with internal and external stakeholder, and collaborating in the development of reports to identify and address Subscriber needs and emerging risks.

Duties and Responsibilities

Claim Review and Coding Tasks

  • Review liability and property claims to identify clinical, risk, insurance and incident related information.
  • Assign initial codes using ICD-10-CA, CCI, and all HIROC loss codes ensuring accurate claim recording.
  • Conduct regular coding audits, arrange coding meetings, and coder education as needed to ensure accuracy.
  • Assist in maintenance of administrative data record integrity.
  • Liaise with adjusters/subscribers in gathering data related to health information release, storage, copying and transfer in electronic health records and portals.
  • Maintain the HIROC coding manual, including coding conventions based upon claim type.
  • Ensure strict confidentiality of patient information in accordance with PHIPA.

Analysis and Preparation of Report Tasks

  • Coordinate and evaluate audit processes to ensure coded data quality and integrity.
  • Provide Risk Lead with monthly and quarterly reports on QA, training and learning activities. 
  • Investigate coding questions, research solutions, and proposed resolutions to enhance data capture quality.
  • Provide oversight and assist in improving data and information quality, including the development of new data elements, taxonomies, and audit procedures. 
  • Ensure appropriate storage, maintenance, and retention of QA records, documentation, information sheets, and learning materials.
  • Assist in developing ad-hoc/standard reports related to identified risks.
  • Conduct education and informational analysis for external stakeholders (e.g., CMPA, Subscribers, ISMP).
  • Analyze data using various software tools, presenting complex ideas clearly to diverse audiences.
  • Assist in the preparation of supplemental Partnership reports including risk management issues and trending.
  • Collaborate with HSRM team members, and IT Business Analyst to ensure all necessary components for risk management reports are available.

Other Functions

  • Participate in continuous educational opportunities to stay current on health information and risk management issues.
  • Contribute to Risk Assessment Checklists development, highlighting trending and significant claims data.
  • Review and edit tools and resources (i.e., Risk Reference Sheets, Case Studies, Risk Notes, Infographic, etc.)
  • Participate in/lead ad hoc HSRM and HIROC projects, initiatives and committees.
  • Facilitate continuing education for CHIMA members, acting as preceptor for CHIM students from an accredited college.
  • Performance of other duties as required.

Skills and Attributes Required

  • Attention to detail.
  • Well-developed statistical and data analysis skills.
  • Computer proficiency, familiarity with Microsoft Office suite, ability with Excel functions and pivot tables.
  • Ability to work under pressure and meet deadlines.
  • Ability to work independently and as a team member.
  • Willing to demonstrate initiative.
  • Good time management skills.
  • Excellent written, verbal and listening skills.

Education Required

  • Graduate from a recognized Health Information Management/Professional program.
  • Qualification in a Health Information Management Program or Nursing Program or other health discipline.
  • Certification with the Canadian Health Information Management Association in good standing is required.

Experience Required

  • Minimum 3 years of previous experience in coding required.
  • Demonstrated coding competency in ICD-10-CCA/CCI coding.
  • Excellent knowledge of medical terminology.

Experience/Education Preferred

  • Clinical experience, and current or previous registration as a member of a Regulated Health Provider.
  • Training/quality assurance role, developing and/or delivering end user training.
  • Experience in assessing training needs, developing and/or coordinating related training, reporting, and evaluation.
  • Experience planning, monitoring, and evaluating projects.
  • Experience or training in Microsoft Power BI, use of SQL, and data management an asset.

Working Conditions

  • Hybrid work model

How to Apply

Please submit your résumé to HR@hiroc.com.

In order to be considered for this position, please include a current résumé or detailed qualifications summary with your application. Only those selected for an interview will be contacted.


HIROC is committed to fostering a climate of equity, diversity, inclusion, and accessibility. HIROC respects the diversity of all members of its community and welcomes applications from those who have demonstrated a commitment to the values of equity, diversity and inclusion. Applications from members of groups that have been historically disadvantaged and marginalized, including First Nations, Métis and Inuit peoples, racialized persons, persons with disabilities, those who identify as women, 2SLGBTQ+, individuals who self-identify on the basis of any of the protected grounds under the Human Rights Code and/or others who may contribute to the further diversification of ideas within its community are encouraged. HIROC is committed to fair assessment of a candidate’s abilities, and consideration for diversity of thought, method, and experience, including non-traditional career paths. 

HIROC is committed to providing a barrier-free environment for all stakeholders, including its participants, employees, job applicants, suppliers, the public and any visitors who may enter its premises, access its information, or use its services. As an organization, HIROC respects and upholds the requirements set forth under the Accessibility for Ontarians with Disabilities Act (AODA) and its associated standards and regulations and will ensure that HIROC offers a safe and welcoming environment that is respectful of each person's dignity and independence.