Quality Analyst, Disability Insurance: Evening Shift

DANE STREET LLC

United States
Aug 4th, 2022
Description:

The QA Specialist plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is delivered by the customer requested due date.

Working hours for this position will be 12:00 pm – 8:30 pm EST.

The QA Specialist is responsible for the timely completion and overall completeness of a reviewer report. Completeness is determined by customer requirements, company best practices, and clinical accuracy. In addition, the QA Specialist participates in improving DS processes and works with the Manager to ensure high efficiencies are achieved.

Requirements:

Client Interaction:

  • Provides regular report status updates to the client.
  • Evaluates the Quality of physician’s report and determines if the report will meet all client and jurisdictional standards; the QA Specialist is also responsible for ensuring that the clinical rationale supports the physician’s determinations.
  • Clarifies ambiguous report questions with clients.
  • Distributes final report back to client according to client specific requirements.
  • Receives, coordinates & executes all aspects of clarification & addendum request from the client.
  • Participates in phone calls OR meetings with client(s) when a report is in question.
  • Follow up with client for any missing information that is pertinent to the referral.

Physician Interaction:

  • Works directly with physician to ensure that all client questions are answered and
    supported by clinical rationale.
  • Conduct regular follow up with the physician or their office staff to ensure an on-time
    delivery of the report.
  • Compose and provide verbal or written feedback to the doctor regarding report
    quality.
  • Compose and provide verbal or written requests to the physician or their office staff for clarifications.
  • Receive written or verbal confirmation from the physician that a report has the doctor’s approval and ensures the doctor provides his/her signature for the final report.

Report Analysis:

  • Review each physician report for data accuracy including spelling, grammar &
    punctuation.
  • Responsible for ensuring that all state requirements for reporting are met.
  • Responsible for report format and adhering to each client’s specific requirements.
  • Must ensure that all client special handling instructions with regard to report
    completion and delivery are met.

Additional Duties:

  • May provide oversight to the work of the team members.
  • Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
  • Responsible for the final approval on cases for release to the client.
  • Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

Special projects dependent upon business needs. Other duties as assigned

EDUCATION/CREDENTIALS:
An Associate’s Degree or Bachelor’s Degree is preferred

JOB RELEVANT EXPERIENCE:
Business experience in a healthcare and/or insurance setting is preferred .
QA Specialist Job Description


JOB RELATED SKILLS/COMPETENCIES:

Present exceptional communication skills with a clear understanding of company business lines.
The ability to apply critical thinking, manage time efficiently and meet specific deadlines.
Computer literacy and typing skills are essential.


WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of
sitting and computer work.

If you require alternative methods of application or screening, you must approach DANE STREET LLC directly to request this, as we're not responsible for the employer's application process.

RedHired TIP

For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction.

By applying to a job using RedHired you are agreeing to comply with and be subject to the RedHired Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.

RedHired

All job types
Contract
Full-time
Part-time
Permanent
Temporary
Other

All locations
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Virgin Islands
United States Minor Outlying Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming