Clinical Quality Assurance Coordinator

🔥 0 minutes ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $30 - $33 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔧 QA Engineer (Quality Assurance)

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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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

• Perform quality assurance reviews of peer review reports, correspondences, addendums, and supplemental reviews • Ensure clear, concise, evidence-based rationales support recommendations and determinations • Verify client instructions, specifications, and questions are addressed • Verify clinical citations and references are current and reputable • Ensure report content, format, and professional appearance meet company standards • Ensure appropriate board specialty review and documentation comply with client specifications or state mandates • Verify peer reviewer attestations and absence of conflicts of interest • Ensure provider credentials and signatures are included in final reports • Identify report inconsistencies and contact peer reviewers for clarification or correction • Assist with client complaints and quality assurance issues • Ensure compliance with federal ERISA and state mandates • Provide management insight on consultant quality, availability, and compliance • Promote effective and efficient use of company resources • Participate in educational and training activities • Perform other assigned duties

🎯 Requirements

• High school diploma or equivalent required • Minimum of two years clinical or related field experience, or equivalent combination of education and experience • Experience in peer review, clinical documentation review, or medical necessity assessments • Familiarity with CMS guidelines, InterQual, Milliman/MCG, or payer policies • Prior employment with insurance carriers, TPAs, or managed care organizations • Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values • Ability to perform arithmetic with whole numbers and decimals and compute rates and percentages • Qualified typist with a minimum of 40 W.P.M. • Ability to operate a computer, fax, copier, scanner, and telephone • Knowledge of Microsoft Word, Outlook, Excel, and the Internet • Excellent English usage, grammar, punctuation, and style • Ability to follow instructions accurately • Accuracy, thoroughness, and quality-monitoring skills • Exceptional communication skills • Ability to work independently, prioritize work, and use time efficiently • Ability to maintain confidentiality

🏖️ Benefits

• 100% remote work from home • Medical, vision, and dental benefits • Paid time off • 401k • Fast-paced team atmosphere • Monday to Friday schedule, 8:30am–5:00pm EST