Quality Assurance Coordinator

MES Solutions, LLC; Norwood (MA); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading company is seeking a Remote Clinical Quality Assurance Coordinator. This role involves reviewing peer review reports to ensure quality and compliance with standards. Ideal candidates will have clinical experience, strong communication skills, and proficiency in medical terminology. Join a fast-paced environment with competitive benefits and a focus on excellence.

Benefits

Paid Time Off

401(k)

Qualifications

• Minimum two years clinical experience or equivalent education.
• Knowledge of insurance claims management preferred.

Responsibilities

• Performs quality assurance review of peer review reports.
• Ensures compliance with client specifications and state requirements.

Skills

Medical Terminology

Communication

Accuracy

Confidentiality

Education

RN Preferred

Two Years Clinical Experience

Tools

Microsoft Word

Outlook

Excel

Job description

Job Details

Job Location: Norwood, MA

Position Type: Full Time

Salary Range: $20.00 - $22.00 Hourly

Travel Percentage: None

Description

Are you looking for a position that is challenging, will keep your clinical knowledge sharp, but doing so from the comfort of home?

MES is seeking a self-motivated, high-performing RN to join our team as a Remote Clinical Quality Assurance Coordinator!

This position is 100% remote, and the schedule will be Monday-Friday, with 2 early days (8:00am-4:30pm or 9:00am-5:30pm EST) and 3 late days (12:00pm-8:30pm EST).

The Clinical Quality Assurance Coordinator is responsible for ensuring Peer Review case reports are of the highest quality, integrity, and in full compliance with client contractual agreements, regulatory agency standards, and federal and state mandates.

Are you motivated, energetic, and excited to become part of the MES team? If so, you might be our next team member!

• Performs quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews.
• Ensures clear, concise, evidence-based rationales support all recommendations and determinations.
• Ensures all client instructions and specifications are followed and questions addressed.
• Verifies references are current, reputable, and properly cited in reports.
• Maintains high standards for report content, format, and appearance.
• Ensures appropriate board specialty review and documentation per client and state requirements.
• Verifies reviewer attestations and absence of conflicts of interest.
• Checks provider credentials and signatures on reports.
• Identifies and clarifies inconsistencies within reports.
• Assists in resolving customer complaints and QA issues.
• Adheres to federal ERISA and state mandates.
• Provides insights and guidance on quality and compliance issues.
• Promotes efficient use of resources.
• Participates in training and other activities as needed.
• Performs other duties as assigned.

Qualifications

RN preferred. Minimum two years clinical experience or equivalent education. Knowledge of insurance claims management, peer review, external review, workers' compensation, no-fault, liability, or disability is preferred.

• Strong knowledge of medical terminology, anatomy, physiology, medications, and lab values.
• Basic math skills including rates and percentages.
• Qualified typist (minimum 40 W.P.M).
• Proficient with computers, fax, copier, scanner, and phone.
• Knowledge of Microsoft Word, Outlook, Excel, and internet.
• Excellent English language skills.
• Ability to follow instructions and respond to management directions.
• Accuracy, thoroughness, and quality focus.
• Excellent communication skills.
• Ability to work independently, prioritize, and maintain confidentiality.
• Team-oriented attitude.
• Focus and concentration under distractions.
• Ability to work under pressure.
• Adaptability to change and delays.
• Reliability and punctuality.
• Professional appearance and demeanor.

About Us

MES Solutions provides independent medical examinations and peer review services to various sectors. Since 1978, we have maintained high standards of excellence and compliance.

We are an Equal Opportunity Employer offering a fast-paced environment with competitive benefits, paid time off, and 401(k).