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ExamWorks · 2 days ago

Clinical Quality Assurance Coordinator (31175)

Rockford, IL

Full-time

Onsite

Entry Level

2+ years exp

ExamWorks is a company focused on ensuring the highest quality and integrity of case reports in compliance with various standards. The Clinical Quality Assurance Coordinator is responsible for performing quality assurance reviews and ensuring that all client specifications and regulatory requirements are met.

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Responsibilities

Perform quality assurance review of peer review 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 the appropriate board specialty has reviewed the case in compliance with client specifications 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 contacts the Peer Reviewer to obtain clarification, modification or correction as needed

Assist in resolution of client complaints and quality assurance issues as needed

Ensure all federal ERISA and 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

Qualification

Medical terminologyHIPAA complianceClinical experienceTyping 40 W.P.MMicrosoft OfficeCommunication skillsTime managementTeam-orientedConfidentiality

Required

High school diploma or equivalent required

A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred

Knowledge of the insurance industry, preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, or disability preferred

LPN/LVN/RN may be required based on business needs

Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values

Must be a qualified typist with a minimum of 40 W.P.M

Must have a full understanding of HIPAA regulations and compliance

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 demonstrate exceptional communication skills

Ability to follow instructions and respond to upper managements' directions accurately

Must demonstrate accuracy and thoroughness

Must be able to work independently, prioritize work activities and use time efficiently

Must be able to maintain confidentiality

Must be able to demonstrate and promote a positive team-oriented environment

Must be able to stay focused and concentrate under normal or heavy distractions

Must be able to work well under pressure and or stressful conditions

Must possess the ability to manage change, delays, or unexpected events appropriately

Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time

Ability to read, analyze and interpret common correspondence, medical records, and legal contracts and documents

Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar

Ability to respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community

Ability to effectively present information one-on-one or in small groups