Clinical Quality Assurance Nurse Auditor

🔥 6 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $33 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

👻 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

• Evaluate clinical information received from healthcare providers • Write and/or review Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, missing-record lists, medical bill apportionments, mock billing invoices, and medical summary statements • Perform quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews • Ensure clear, concise, evidence-based rationales support recommendations and determinations • Ensure client instructions, specifications, contractual agreements, regulatory standards, and federal and state mandates are followed • Support reviews with current clinical citations and reputable medical references • Ensure report content, format, and professional appearance meet company standards • Verify appropriate board specialty review and accurate case-report documentation • Verify reviewer attestations, provider credentials, and signatures • Identify report inconsistencies and contact reviewers for clarification, modification, or correction • Recover missing documentation or verify charges • Assist with customer complaints and quality assurance issues • Provide management insight on consultant quality, availability, and compliance • Promote efficient utilization of company resources • Participate in continuing education and training activities • Perform other duties as assigned

🎯 Requirements

• Bachelor/Associate degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience • RN/LPN license • Must hold and maintain an unencumbered Registered Nursing license • Experience with medical terminology, medications, medical specialties and treatment protocols • Experience in the insurance industry preferred • Strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values • Qualified typist with a minimum of 40 W.P.M. • Ability to operate a general computer, fax, copier, scanner, and telephone • Knowledge of Microsoft Word, Outlook, Excel, and the Internet • Excellent skills in English usage, grammar, punctuation and style • Ability to follow instructions and respond to upper management's directions accurately • Ability to work independently, prioritize work activities and use time efficiently • Ability to maintain confidentiality • Ability to stay focused and concentrate with frequent interruptions • Ability to work well under pressure or stressful conditions • Ability to manage change, delays, or unexpected events appropriately • Reliability and adherence to the company attendance policy • Professional and clean appearance consistent with company standards

🏖️ Benefits

• Medical insurance • Vision insurance • Dental insurance • Paid time off • 401k • Fast-paced team atmosphere