Group Health Quality Analyst 1 – Weekend

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

📋 Description

• Interact with customers, reviewers, physicians, office personnel, and management to guarantee the timely delivery of completed reports as per customer requests.

• Ensure the overall completeness and clinical accuracy of physician reports.

• Provide clients with regular updates on report status.

• Assess reports against client and jurisdictional standards.

• Confirm that clinical rationale supports physician conclusions.

• Resolve ambiguous report queries with clients.

• Distribute final reports in accordance with client-specific requirements.

• Coordinate requests for clarification and addendums.

• Engage in client phone calls or meetings when there are questions regarding reports.

• Follow up on any missing referral information.

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

• Ensure on-time report delivery by following up with physicians or office staff.

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

• Obtain physician approval, confirmation, and signatures for final reports.

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

• Ensure compliance with state reporting requirements and client-specific formats.

• Adhere to client special handling instructions for report completion and delivery.

• Offer oversight to team members as necessary.

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

• Grant final approval for case releases to clients.

• Coordinate quality issue reports and new reviewer reports with the VP of Clinical Operations.

• Execute additional duties and special projects as assigned.

⛳️ Requirements

• An active LPN or RN license is required.

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

• 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 required.

• Ability to apply critical thinking is necessary.

• Strong time management skills to meet specific deadlines are essential.

• Proficient computer skills and typing abilities are required.

• Must supply and support own internet services.

• Maintain a reliable internet connection for remote work.

• Ability to perform necessary lifting, bending, traveling, and extended periods of sitting/computer work is expected.

🏝️ Benefits

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

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

• Voluntary plans for hospital indemnity, critical illness, accident indemnity, and pet insurance.

• Basic life insurance provided at no cost.

• Short-term disability coverage provided at no cost.

• Long-term disability coverage provided at no cost.

• Generous paid time off policies.

• 401(k) plan with company matching contributions.

• Apple equipment provided for remote workspaces.

• Media stipend for remote workspaces.

• Flexible remote work arrangement.