Medical QA Case Coordinator – Reports & Compliance

Advanced Medical Reviews, Inc.; Long Beach (CA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical benefits

Vision benefits

Dental benefits

401k

Job summary

Advanced Medical Reviews, Inc. is seeking a Case Coordinator to ensure high-quality, compliant reports and robust quality assurance support for the QA Department.

The role involves QA reviews, evidence-based rationales, and adherence to client specifications, IRSA/state mandates, and professional standards. Responsibilities include coordinating with peer reviewers, maintaining documentation integrity, and assisting in resolving client inquiries and issues while upholding confidentiality and team

Qualifications

• High school diploma or equivalent required.
• Minimum two years clinical or related field experience or equivalent.
• Knowledge of the insurance industry preferably claims management related to 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 operate a computer, fax, copier, scanner, and telephone.
• Must be a qualified typist with a minimum of 40 WPM.
• Excellent English usage, grammar, punctuation and style.

Responsibilities

• Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
• Ensures evidence-based rationales support recommendations and determinations.
• Ensures client instructions and specifications are followed and questions addressed.
• Cites current, reputable medical literature to support references.
• Maintains high quality content, format, and professional appearance of reports.
• Ensures appropriate board specialty review and accurate documentation.
• Verifies peer reviewer attestation and absence of conflicts of interest.
• Ensures provider credentials and signature are on the final report.
• Identifies inconsistencies and seeks clarification or corrections as needed.
• Assists in resolution of customer complaints and QA issues.
• Ensures ERISA/state mandates are adhered to at all times.
• Provides guidance to management on quality, consultant availability, and compliance.
• Promotes efficient use of company resources.
• Participates in training activities and other duties as assigned.

Skills

Medical terminology

Anatomy & physiology

Attention to detail

Communication skills

Time management

Discretion/confidentiality

Typing 40 WPM

Independent work

Team collaboration

Education

High school diploma or equivalent

Two years clinical or related field experience

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Internet

Job description

Advanced Medical Reviews, Inc. is seeking a Case Coordinator to ensure high-quality, compliant reports and robust quality assurance support for the QA Department.

The role involves QA reviews, evidence-based rationales, and adherence to client specifications, IRSA/state mandates, and professional standards. Responsibilities include coordinating with peer reviewers, maintaining documentation integrity, and assisting in resolving client inquiries and issues while upholding confidentiality and team