Remote Clinical QA Nurse Auditor (RN) - Precision Reporting

MES Solutions; Winslows (MA); Remote; USD 85,000 - 120,000; Full time

Benefits offered by this job

Medical, vision, dental benefits

Paid time off

401k

Job summary

MES Solutions seeks a self-driven, high-performing RN or LPN to join our team as Clinical Quality Assurance Nurse Auditor. You will evaluate clinical information, generate reports, and ensure compliance with client contracts and regulations.

This 100% remote role offers a steady daytime schedule (EST) and the chance to impact quality across cases. You will review medical records, author rationales with citations, resolve inconsistencies, and assist in addressing customer concerns.

Qualifications

• Bachelor/Associate degree in nursing or related field or equivalent experience.
• Experience with medical terminology, medications, medical specialties and treatment protocols.
• Experience in the insurance industry preferred.

Responsibilities

• Evaluate clinical information received, write and/or review reports including 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 review of peer review reports, correspondences, addendums or supplemental reviews.
• Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensure client instructions and specifications are followed and all questions addressed.
• Ensure each review is supported by clinical citations and references from reputable journals.
• Ensure content, format, and professional appearance of reports meet company standards.
• Verify appropriate board specialty reviewed the case and documented on the report.
• Verify reviewer attested to facts and no conflict of interest exists.
• Ensure provider credentials and signature are adhered to in final report.
• Identify inconsistencies and contact the Reviewer to obtain clarifications.
• Assist in resolution of customer complaints and quality assurance issues.
• Ensure all federal ERISA or state mandates are adhered to.
• Provide insight on consultant quality, availability and compliance with policies.
• Promote efficient utilization of company resources.
• Participate in continuing education and training activities.
• Perform other duties as assigned.

Skills

Medical terminology & protocols

Education

Bachelor/Associate nursing or related field

Tools

Microsoft Word, Outlook, Excel, Internet

Job description

MES Solutions seeks a self-driven, high-performing RN or LPN to join our team as Clinical Quality Assurance Nurse Auditor. You will evaluate clinical information, generate reports, and ensure compliance with client contracts and regulations.

This 100% remote role offers a steady daytime schedule (EST) and the chance to impact quality across cases. You will review medical records, author rationales with citations, resolve inconsistencies, and assist in addressing customer concerns.