Quality Assurance Specialist
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Job Description
Quality Assurance Specialist reviewing medical, behavioral health, and scientific reports for R3 Continuum. Ensuring accurate, compliant case documents through specialist feedback and HIPAA-conscious quality controls.
Responsibilities:
- Complete quality assurance reviews on each report, letter, and appendix
- Provide clear and concise edits to specialists and ensure documents are error-free and delivered on time
- Review content for consistency and clarity
- Ensure network specialist answers all customer-requested questions
- Review completeness of reports, letters, and appendices and verify customer instructions were followed
- Identify potential clinical content inconsistencies and collaborate with Clinical Manager, Quality Assurance, and/or Clinical Subject Matter Experts
- Facilitate and document panel calls between network specialists as needed
- Send letters to attending physicians via fax or mail
- Send finalized reports and case documents to customers
- Identify network panelist quality issues and resolve them through feedback and training
- Refer network panelists to the Training Department when necessary
- Use R3 Continuum’s eCase Manager online portal for QA tasks
- Document communications with network specialists and completed work in eCM
- Monitor workload using eCM reports
- Maintain confidentiality under HIPAA guidelines
- Assist in gathering case documents for legal records requests
- Participate in process improvement initiatives and special projects
- Participate in department and company meetings
- Perform other assigned duties
Requirements:
- Ability to develop and foster relationships with employees, network panelists, and customers at all levels of the organization
- Ability to give clear, consistent, and concise direction and communication with network panelists and team members
- Good judgment and ability to make timely and sound decisions based on data and business acumen
- Ability to recall and independently apply QA concepts across multiple areas
- Familiarity with medical and mental health terminology
- Highly proficient verbal and written communication
- Excellent grammar and spelling skills
- Excellent interpersonal and customer service skills
- Excellent organizational skills and attention to detail
- Ability to multitask and quickly switch between unrelated tasks
- Excellent time management skills and proven ability to meet deadlines
- Strong critical thinking, analytical, and problem-solving skills
- Ability to function well in a high-paced and at times stressful environment
- Proficient with Microsoft Office Suite or related software
- Basic mathematics skills
- Bachelor’s degree required, preferably in psychology or behavioral health
- Master’s degree preferred, preferably in a human or natural science, from an accredited college or university
- 3 years of previous experience reviewing reports with medical, behavioral health, and/or scientific content preferred
- 3 years of previous experience working and communicating with medical professionals preferred
- 3 years of previous experience in the disability or workers’ compensation insurance industry or similar preferred
- Ability to maintain confidentiality utilizing HIPAA guidelines
- Overtime/additional hours may be mandatory during increased workload periods
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
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