Quality Assurance Specialist

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

📋 Description

• Conduct quality assurance evaluations on every report, letter, and appendix.

• Deliver clear and concise edits to specialists, ensuring documents are free of errors and submitted punctually.

• Assess content for uniformity and clarity.

• Guarantee that network specialists address all inquiries from customers.

• Verify the completeness of reports, letters, and appendices, ensuring adherence to customer instructions.

• Detect potential inconsistencies in clinical content and collaborate with the Clinical Manager, Quality Assurance, and/or Clinical Subject Matter Experts.

• Organize and document panel calls among network specialists as required.

• Dispatch letters to attending physicians through fax or mail.

• Send finalized reports and case documentation to clients.

• Identify quality issues among network panelists and address them through feedback and training.

• Refer network panelists to the Training Department when appropriate.

• Utilize R3 Continuum’s eCase Manager online portal for quality assurance tasks.

• Record communications with network specialists and document completed work in eCM.

• Monitor workload utilizing eCM reports.

• Uphold confidentiality in accordance with HIPAA guidelines.

• Assist in collecting case documents for legal record requests.

• Engage in process improvement initiatives and special projects.

• Participate in departmental and company meetings.

• Carry out other assigned responsibilities.

⛳️ Requirements

• Capability to build and nurture relationships with employees, network panelists, and customers across all organizational levels.

• Ability to provide clear, consistent, and concise direction and communication with network panelists and team members.

• Sound judgment and the capability to make timely and informed decisions based on data and business insight.

• Competence in recalling and independently applying quality assurance concepts across various areas.

• Familiarity with medical and mental health terminology.

• Highly skilled in both verbal and written communication.

• Exceptional grammar and spelling abilities.

• Strong interpersonal skills and a commitment to customer service.

• Outstanding organizational skills and meticulous attention to detail.

• Ability to manage multiple tasks and swiftly transition between unrelated duties.

• Excellent time management skills with a proven ability to meet deadlines.

• Strong critical thinking, analytical, and problem-solving abilities.

• Ability to thrive in a fast-paced and occasionally stressful environment.

• Proficient in Microsoft Office Suite or similar software.

• Basic mathematical skills.

• Bachelor’s degree is required, preferably in psychology or behavioral health.

• A Master’s degree is preferred, ideally in a human or natural science, from an accredited institution.

• At least 3 years of prior experience reviewing reports that involve medical, behavioral health, and/or scientific content is preferred.

• A minimum of 3 years of experience in working with and communicating with medical professionals is preferred.

• At least 3 years of experience in the disability or workers’ compensation insurance sector or a similar field is preferred.

• Ability to maintain confidentiality in compliance with HIPAA regulations.

• Overtime or additional hours may be required during periods of increased workload.

🏝️ Benefits

• Paid time off (PTO).

• Paid parental leave.

• Paid holidays.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Life insurance.

• Short-term disability insurance.

• Long-term disability insurance.

• Flexible schedules.

• 401k program with company match.

• Profit sharing.

• Employee training and development.

• Growth opportunities.