Clinical Quality Assurance Coordinator

🔥 7 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $30 - $31 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

🚫👨‍🎓 No degree required

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MES Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1978

⚕️ Healthcare Insurance

🤝 B2B

🏛️ Government

Healthcare Insurance • B2B • Government

MES Solutions is a provider of independent medical evaluation and peer review services for the claims and risk-management community. The company coordinates Independent Medical Examinations (IMEs), record retrieval and record reviews, peer review services, physician credentialing, and fitness-for-duty and disability assessment support. Its clients include insurers, third-party administrators, self-insured employers, government agencies, and attorneys across auto, disability, liability, workers' compensation, and group health markets, and it emphasizes compliance with HIPAA, HITECH, and HITRUST.

📋 Description

• Responsible for ensuring case reports are of the highest quality and integrity. • Handle quality assurance questions and provide support to the Quality Assurance Department. • Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. • Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. • Ensure that all client instructions and specifications have been followed and that all questions have been addressed. • Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. • Assist in resolution of client complaints and quality assurance issues as needed.

🎯 Requirements

• High school diploma or equivalent required. • Minimum of two (2) years of clinical or related experience preferred, or an equivalent combination of education and experience. • Knowledge of the insurance industry, including claims management (workers’ compensation, no-fault, liability, or disability), preferred. • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. • Must be a qualified typist with a minimum of 40 W.P.M. • Must have a full understanding of HIPAA regulations and compliance. • Must be able to operate a general computer, fax, copier, scanner, and telephone. • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. • Ability to follow instructions and respond to upper managements’ directions accurately. • Must be able to maintain confidentiality.

🏖️ Benefits

• Health insurance • Professional development opportunities