ExamWorks

QA Engineer

• Receive client submissions and input client and examinee data in the system.
• Verify all cases contain information needed for the clinical review process.
• Maintain daily contact with the Clinical QA Department regarding workflow and status of pending reports.
• Track documentation of all processes, communications, report status and due dates.
• Maintain a daily log of files that require follow up, clarification or concerns in the tracker.
• Receive completed reports and review for completeness and accuracy, including proper formatting, grammar and sentence structure.
• Complete and or ensures all invoicing is billed daily and in accordance with company practices and client contract agreements.
• Handle and respond promptly to incoming communication from physicians or clients requesting report status or information.
• Work with transcriptionists and/or physicians’ offices regarding report details, clarification, addendums, etc.
• Ensure all medical records and reports are properly documented and saved in the appropriate location.
• Notify management of any report issues or concerns.
• Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations.
• Promote effective and efficient utilization of clinical resources and supplies.
• Perform other duties as assigned.

Clerical Quality Assurance Coordinator

• Review and refine critical medical reports, chronologies, and provider bills to ensure flawless clinical accuracy and professional presentation.
• Verify that every clinical determination is backed by robust, current citations from reputable medical journals.
• Collaborate directly with reviewing physicians to clarify complex case details and resolve inconsistencies.
• Ensure full alignment with federal ERISA regulations, state mandates, and client specifications, while strictly verifying that no conflicts of interest exist.
• Help resolve client quality questions, recover missing medical data, and provide management with strategic insights on consultant performance.

Clinical Quality Assurance Nurse Auditor

Client Coordinator

• Handle and respond promptly to inquiries from clients and/or anyone acting on behalf of the client regarding questions, report status, concerns, or general requests for information
• Utilize appropriate systems and databases to enter client or claimant information and or retrieve information
• Maintain daily contact with the QA department regarding workflow and pending report status
• Contact providers for assignment and update database
• File and archive open and closed cases
• Verify all client information is current in the database and all client specific guidelines and or rules or information is documented in the system
• Work independently and in partnership with other team members to ensure that questions are addressed, documented and cases are returned in a timely fashion
• Direct calls to other departments as needed
• Perform various clerical duties such as typing, filing, emailing, and proofreading
• Assist in resolution of customer complaints and quality assurance issue
• Notify management of any report issues or concerns
• Ensure all practices are carried out in accordance with state and federal safety and legal regulations
• Perform other duties as assigned

Therapist

• Treat individuals experiencing various neurological, orthopedic disorders, and mental health injuries.
• Collaborate with supervising therapists to assist clients with establishing and meeting meaningful goals in a variety of settings including client homes, their local community, community centres, gyms, public libraries, etc. within the Greater Vancouver area.
• Assist in the delivery of individualized treatment plans based on analysis and clinical reasoning of supervising therapists.
• Liaise with a variety of community partners and rehab professionals (OTs, PTs, SLPs, SWs, etc.) to facilitate client goals and independence.

Occupational Therapist Assistant

• 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 determinations.
• Ensures 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.
• Perform other duties as assigned.

Clinical Quality Assurance Coordinator

• Handle and respond promptly to inquiries from clients and/or anyone acting on behalf of the client regarding questions, report status, concerns, or general requests for information.
• Utilize appropriate systems and databases to enter client or claimant information and or retrieve information.
• Maintain daily contact with the QA department regarding workflow and pending report status.
• Contact providers for assignment and update database.
• File and archive open and closed cases.
• Verify all client information is current in the database and all client specific guidelines and or rules or information is documented in the system.
• Work independently and in partnership with other team members to ensure that questions are addressed, documented and cases are returned in a timely fashion.
• Direct calls to other departments as needed.
• Perform various clerical duties such as typing, filing, emailing, and proofreading.
• Assist in resolution of customer complaints and quality assurance issue.
• Notify management of any report issues or concerns.
• Ensure all practices are carried out in accordance with state and federal safety and legal regulations.
• Perform other duties as assigned.

• Evaluate clinical information received, write and/or review various reports including, but not limited to: Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements.
• Perform quality assurance reviews of peer review reports, correspondences, addendums or supplemental reviews to ensure they meet company standards for content, clarity, evidence-based rationale, formatting, and professional presentation.
• Ensure all client instructions and specifications have been followed, all questions have been answered, and all recommendations or determinations are supported by clear, concise, and evidence-based rationales.
• Verify that each review includes appropriate clinical citations when applicable, and ensure all references cited are current and obtained from reputable medical journals and publications.
• Identify inconsistencies within reports and contact the reviewer to obtain clarifications, modifications, or corrections needed.
• Assist in the resolution of customer complaints and quality assurance issues as appropriate.
• Ensure all federal ERISA and applicable state mandates are adhered to.
• Provide ongoing feedback and recommendations to management regarding consultant performance, quality trends, and compliance with internal and client specific requirements.
• Participate in the development and implementation of policies and procedures to improve efficiency and quality across operations.
• Develop and lead formal and informal training sessions -individually or in groups -that promote high-quality utilization review practices and reinforce company standards.
• Develop and document new or improved operational processes to support continuous improvement.
• Promote effective and efficient utilization of company resources across all responsibilities.
• Participate in or lead various continuing education and training activities related to clinical knowledge, industry standards, and company processes.
• Perform other duties as assigned.

Utilization Review, Quality Assurance Specialist

Planner

• The Planner works autonomously to develop Medicare Set-Aside Allocations and other reports as needed within their scope of licensing and/or certifications.
• Collects, reviews and analyzes health data from medical records and/or other sources as provided.
• Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care.
• Work autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed.
• Maintain a quality work product evidenced by acceptable quality scores/score cards.
• Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company.
• Attend all scheduled conference calls as mandated by management.
• Maintain any required credentials and adhere to all codes of ethics required by these credentials.
• Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times.
• Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
• Perform professional duties as assigned by the Manager or upper management.

Technician

• Prepare, print, sort, scan, process and maintain electronic and/or hard copies of charts, medical report forms or company documents
• Will gather and organize examinee charts for examinations and/or deposition purposes
• Finalize completed charts by confirming all records are included and consolidate charts in proper order
• Prepare and ship records to physicians utilizing appropriate mailing sources within required timeframes
• Perform clerical duties such as typing, filing, emailing, and proofreading as required

Document Management Technician

Medical Billing and Coding

• Create and write reports based on medical records and appropriate guideline criteria
• Analyze provider billing for proper coding and billing guidelines
• Perform quality assurance on every case prior to completion
• Ensure all medical records and reports are properly documented and available for audit
• Process client invoicing in accordance with the client’s fee schedule
• Contact client as needed for inquiries
• Provide testimony in court as to the content of prepared reports, as required

Clerical Quality Assurance Coordinator

Clinical Quality Assurance Nurse Auditor

Client Coordinator

Occupational Therapist Assistant

Clinical Quality Assurance Coordinator

Client Coordinator

Client Coordinator

Utilization Review, Quality Assurance Specialist

Planner

Document Management Technician

Medical Coding Specialist