Quality Assurance Specialist (LPN/LVN): Group Health

Dane Street; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company is seeking a Quality Assurance Specialist (RN/LPN) to ensure the accuracy and compliance of reports. The role involves client and physician interaction, report analysis, and process improvements. The ideal candidate will have strong communication and critical thinking skills, along with a required RN or LPN license.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Coverage

Paid Time Off

401k with Match

Equipment Stipends

Qualifications

• RN or LPN license is required.
• Healthcare or insurance-related experience is preferred.

Responsibilities

• Provide regular report status updates to clients.
• Evaluate physician reports for quality and compliance.
• Review reports for data accuracy and compliance.

Skills

Communication

Critical Thinking

Time Management

Computer Literacy

Typing

Education

Associate's Degree

Bachelor's Degree

Job description

Quality Assurance Specialist (RN/LPN): Group Health

The QA Specialist plays an integral role in the review process by communicating with customers, reviewers, and management to ensure reports are completed and delivered by the requested due date.

The QA Specialist is responsible for the timely and complete submission of reviewer reports, ensuring they meet customer requirements, company standards, and clinical accuracy. They also participate in process improvements and collaborate with the Manager to enhance efficiency.

Dane Street values individual and team contributions, fostering a positive environment focused on client satisfaction and results.

Major Duties & Responsibilities

Client Interaction

• Provide regular report status updates to clients.
• Evaluate physician reports for quality and compliance with standards; ensure clinical rationale supports determinations.
• Clarify ambiguous report questions with clients.
• Distribute final reports according to client requirements.
• Handle clarification and addendum requests from clients.
• Participate in calls or meetings regarding reports.
• Follow up on missing or pertinent information from clients.

Physician Interaction

• Collaborate with physicians to answer questions and support reports with clinical rationale.
• Follow up with physicians to ensure timely delivery.
• Provide feedback to physicians on report quality.
• Request clarifications from physicians as needed.
• Obtain physician approval and signature for final reports.

Report Analysis

• Review reports for data accuracy, spelling, grammar, and punctuation.
• Ensure compliance with state reporting requirements.
• Adhere to client-specific report formats and instructions.
• Meet all client handling and delivery instructions.

Additional Duties

• Oversee team members' work as needed.
• Improve processes to enhance turnaround times, peer success, and reduce clarifications, increasing client satisfaction.
• Approve cases for release to clients.
• Coordinate quality issues and new reviews with the VP of Clinical Operations.

Other duties and projects may be assigned based on business needs.

Requirements

Education/Credentials: An Associate's or Bachelor's Degree is preferred. RN or LPN license is required.

Experience: Healthcare or insurance-related experience is preferred.

Skills: Excellent communication, critical thinking, time management, computer literacy, and typing skills.

Working Conditions & Technical Requirements

Includes lifting, bending, travel, long periods of sitting and computer use. For remote work, maintaining an uninterrupted internet connection and providing your own internet service are required.

Benefits

Comprehensive benefits including medical, dental, vision, voluntary life insurance, disability coverage, paid time off, 401k with match, equipment, and stipends.

About Dane Street

A fast-growing Inc. 500 company processing over 200,000 claims annually, providing IMEs and peer review programs for various clients in the healthcare and insurance sectors.