Group Health Quality Analyst 1 – Nights

This is a fully remote position, open to applicants in United States.

📋 Description

• Interact with customers, reviewers, physicians, office personnel, and management to guarantee that completed reports are submitted by the deadlines requested by clients.

• Ensure that reviewer reports are delivered promptly, are comprehensive, clinically precise, and adhere to customer specifications, company best practices, and jurisdictional regulations.

• Provide clients with regular updates on report statuses.

• Resolve any ambiguous questions regarding reports with clients.

• Distribute final reports according to the specific requirements set by clients.

• Coordinate client requests for clarifications and addendums.

• Engage in client phone calls or meetings concerning disputed reports.

• Follow up with clients to retrieve any missing referral information.

• Collaborate directly with physicians to address client inquiries and support clinical justifications.

• Ensure timely delivery of reports by following up with physicians or office staff.

• Provide verbal or written feedback and requests for clarification to physicians.

• Secure physician approval and signatures for final reports.

• Review physician reports for accuracy of data, spelling, grammar, and punctuation.

• Ensure compliance with state reporting requirements, report formatting, client specifications, and special handling instructions.

• Offer oversight to team members as necessary.

• Enhance processes to improve turnaround times, peer-to-peer success rates, and client satisfaction.

• Grant final approval for cases before they are released to clients.

• Collaborate with the VP of Clinical Operations to manage quality issue reports and new reviewer reports.

• Undertake additional responsibilities and special projects as assigned.

⛳️ Requirements

• An Associate’s or Bachelor’s Degree is preferred.

• A valid LPN or RN license is required.

• Prior business experience in a healthcare and/or insurance environment is preferred.

• Outstanding communication skills are essential.

• A clear understanding of the company’s business lines is necessary.

• Ability to apply critical thinking skills effectively.

• Strong time management skills and the ability to meet specific deadlines are required.

• Proficiency in computer literacy and typing skills is expected.

• Must be able to provide and support personal internet services.

• An uninterrupted internet connection is required for the work-from-home role.

• Capability to perform necessary lifting, bending, traveling, prolonged sitting, and computer work is essential.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage for employees and their families.

• Optional life insurance for employees, their spouses, and children.

• Additional voluntary plans including hospital indemnity, critical illness, accident indemnity, and pet insurance.

• Basic life insurance provided at no cost.

• Short-term disability coverage offered at no cost.

• Long-term disability coverage provided at no cost.

• Paid time off to promote work-life balance.

• 401(k) plan with company matching contributions.

• Apple equipment provided to facilitate a remote workspace.

• Media stipend available for remote workspace needs.

• Flexible remote work arrangement.