Clinical Quality Assurance Coordinator

October 29

🍂 Massachusetts – Remote

Although this job is listed in Massachusetts, this company may be open to hiring remote in other states.

💵 $29 - $31 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

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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

• 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. • 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. • 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. • Promote effective and efficient utilization of company resources. • Participate in various educational and or training activities as required. • Perform other duties as assigned.

🎯 Requirements

• Active 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. • 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.