Note: The job is a remote job and is open to candidates in USA. Clay Consulting, LLC is seeking a Clinical Quality Assurance Coordinator to join their team. In this role, you will review medical records, ensuring quality and compliance while crafting detailed narrative summaries.
Responsibilities
- 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 determinationsEnsures 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
Skills
- High school diploma or equivalent required
- 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. Look for ways to improve and promote quality and monitors own work to ensure quality is met
- 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
- 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
Benefits
- 100% Remote – Work from where you're most comfortable - home!
- Flexible Hours –Monday-Friday 8:00am-4:30pm early shift (3 days) 10:00am-6:30pm (1 day) and 12pm-8:30pm (1 day) ALL ET
- Great Training – The first 4-6 weeks of training are designed to set you up for success, with a preferred training schedule of 12:00pm- 8:30pm EST.
Company Overview