Clinical Quality Assurance Coordinator

🕒 July 29

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $27 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

ExamWorks

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2008

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

ExamWorks is a leading provider of independent medical examinations and peer reviews, specializing in services such as bill reviews, Medicare compliance, and document management. With a robust portfolio that includes agile development and enterprise platform solutions, ExamWorks ensures efficient workflow enhancements and compliance auditing across healthcare sectors. The company supports a network of physicians and offers customized services for the management of medical records and claims, prioritizing reliability for clients in various communities.

📋 Description

• Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations • Ensures that all client instructions and specifications have been followed and that all questions have been addressed • Ensures 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 • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards • Verifies 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 • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists • Ensures the provider credentials and signature are adhered to the final report • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed • Assists in resolution of customer complaints and quality assurance issues as needed • Ensures all federal ERISA and/or state mandates are adhered to at all times • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications • Promotes effective and efficient utilization of company resources • Participates in various educational and or training activities as required • Performs other duties as assigned.

🎯 Requirements

• Active RN/LPN nursing license required • Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred • A minimum of two years clinical or related field experience; or equivalent combination of education and experience • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values • Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages • 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 • 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.

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off