Quality Assurance Coordinator

October 29

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MES Solutions

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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.

201 - 500 employees

Founded 1978

⚕️ Healthcare Insurance

🤝 B2B

🏛️ Government

📋 Description

• The Quality Assurance Coordinator is responsible to ensure reports are completed at the highest level of quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. • This position is required to handle quality assurance questions and provide overall support to the Quality Assurance Department. • Perform quality assurance review of 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. • Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. • Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report. • Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. • Ensure the provider credentials and signature are adhered to the final report. • Identify any inconsistencies within the report and contact the Provider to obtain clarification, modification or correction as needed. • Assist in resolution of customer complaints and quality assurance issues as needed. • Ensure all federal ERISA and/or state mandates are adhered to at all times. • Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. • Promote effective and efficient utilization of company resources. • Participate in various educational and or training activities as required. • Perform other duties as assigned.

🎯 Requirements

• Must be a qualified typist with a minimum of 40 W.P.M • 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. • Must possess excellent skills in English usage, grammar, punctuation and style. • Ability to follow instructions and respond to upper managements’ directions accurately. • Demonstrates accuracy and thoroughness. • Looks for ways to improve and promote quality and monitors own work to ensure quality is met. • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. • Must be able to work independently, prioritize work activities and use time efficiently. • Must be able to maintain confidentiality.