Quality Assurance Specialist, Clinical RN – Disability
Dane Street
Claims Quality Analyst
Dane Street
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Manage various aspects of the medical file review process, including reviewing completed referrals and reports for accuracy
- Review reports accompanying medical records to ensure completeness and that client questions have been addressed
- Follow up with reviewers for additional questions or clarifications and with clients if further questions arise
- Update clients frequently on referral progress and format reports for approval
- Ensure reports adhere to QA checklist and are grammatically correct with no spelling errors
- Communicate clearly and concisely among the customer, reviewer, and Operations team
- Speak confidently with physicians and clients regarding the content of peer reviews
- Perform other duties and special projects as assigned; maintain a positive working environment
- Work-from-home duties include long periods of sitting and computer work; may require lifting, bending, or travel as needed
Requirements
- Associate’s Degree or Bachelor’s Degree preferred
- Business experience in a healthcare and/or insurance setting preferred
- NY Workers Compensation experience preferred
- Operations experience with Peer Review, UR and/or case management
- Experience working with technology-based processes within the business environment
- Exceptional communication skills; must confidently speak with physicians and clients regarding peer reviews
- Ability to apply critical thinking, manage time efficiently, and meet specific deadlines
- Computer literacy and typing skills
- Ability to handle high volume and meet deadlines
- Supply and support own internet services and maintain an uninterrupted internet connection for work-from-home positions
