IME RESOURCES LLC

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management, and related services. Clients include property and casualty insurance carriers, law firms, third-party claim administrators, and government agencies. Services confirm the veracity of claims by sick or injured individuals under automotive, disability, liability, and workers' compensation insurance coverages.

Clinical Quality Assurance Coordinator (31677)

QA EngineerQA EngineerFull TimeRemoteTeam 2-10

Location

United States

Posted

4 days ago

Salary

$27 - $31 / hour

Medical TerminologyAnatomy AND PhysiologyClinical Quality AssurancePeer ReviewERISA ComplianceClaims ManagementMicrosoft WordMicrosoft ExcelMicrosoft OutlookComputer LiteracyTypingEnglish GrammarMedical Record Review

Job Description

Job DetailsJob Location: Norwood, MA 02062Position Type: Full TimeSalary Range: $27.00 - $31.25 HourlyTravel Percentage: NoneReady for Your Next Big Career Move? Use Your Clinical Expertise - All Without Leaving Home! Are you a Registered Nurse (RN) looking for a role that challenges you, supports your growth, and offers true work‑life balance? MES has an incredible opportunity that lets you make an impact from the comfort of your couch. We’re seeking a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll ensure our Peer Review case reports consistently meet the highest standards of quality, accuracy, and compliance with client requirements, regulatory guidelines, and federal/state mandates.   100% Remote – Work where you’re most comfortable and productive. Meaningful Impact – Your expertise directly supports the integrity of our clinical review process. Flexible Schedule - Monday through Friday with rotating (approximately every 4 weeks) weekends. Three days of 8:00am-4:30pm EST and two days of 12:00pm-8:30pm EST (One of which is Friday) Responsibilities include: 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 that all client instructions and specifications have been followed and that all questions have been addressed. Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report. Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assist in resolution of client complaints and quality assurance issues as needed. Ensure all federal ERISA and state mandates are adhered to at all times. Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned.   QualificationsHigh school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.   Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.  Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality.     MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.   MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.   Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

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