MES Solutions · 1 week ago
Clinical Quality Assurance Coordinator
United States
Full-time
Remote
Entry, Mid Level
2+ years expMES Solutions is a premier provider of independent medical examination and peer review services. They are seeking a Clinical Quality Assurance Coordinator responsible for ensuring the quality and compliance of Peer Review case reports with regulatory guidelines and client agreements.
GovernmentHealth CareMedical
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
Required
High school diploma or equivalent required
A minimum of two years clinical or related field experience; or equivalent combination of education and experience
Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability
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
Benefits
Medical
Vision
Dental
Paid time off
401k
Company
MES Solutions
MES Solutions and MES Peer Review Services provide physicians with expertise in conducting Independent Medical Examinations
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase