Clinical Quality Assurance Coordinator (32574)

MES Solutions•Norwood, MA

1d•$27 - $29•Remote

About The Position

MES Solutions is looking for a Clinical Quality Assurance Coordinator Supervisor to join their team! The Clinical Quality Assurance Coordinator Supervisor is responsible to oversee the daily workflow of the Quality Assurance Department and provide leadership and direction to ensure operations run as efficiently and effectively as possible. This position is required to have a complete understanding of the duties required below and provide overall direction and support to the Quality Assurance Department. This is a 100% fully remote role with a schedule of: Monday-Friday 12:00pm -8:30PM EST.

Requirements

High school diploma or equivalent required.
A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred.
Knowledge of the insurance industry, preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, or disability preferred.
Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
Must be a qualified typist with a minimum of 40 W.P.M
Must have a full understanding of HIPAA regulations and compliance.
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 demonstrate exceptional communication skills.
Ability to follow instructions and respond to upper managements’ directions accurately.
Must demonstrate accuracy and thoroughness.
Look for ways to improve and promote quality and monitors own work to ensure quality is met.
Must be able to work independently, prioritize work activities and use time efficiently.
Must be able to maintain confidentiality.
Must be able to demonstrate and promote a positive team -oriented environment.
Must be able to stay focused and concentrate under normal or heavy distractions.
Must be able to work well under pressure and or stressful conditions.
Must possess the ability to manage change, delays, or unexpected events appropriately.
Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
Ability to read, analyze and interpret common correspondence, medical records, and legal contracts and documents.
Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
Ability to respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community.
Ability to effectively present information one-on-one or in small groups.

Nice To Haves

LPN/LVN/RN may be required based on business needs.

Responsibilities

Coordinate and direct the QA department’s daily workflow to ensure all product lines are completed with the highest level of quality in the most effective and efficient manner possible.
Prioritize and manage the daily workload and ensure the appropriate and equitable distribution of work is maintained in order to achieve goals.
Monitor work product to ensure clear, concise, evidence-based rationales have been provided in support of all recommendations or determinations and that specific indicators and criteria in accordance with company policy and procedures have been achieved.
Ensure department compliance of all federal ERISA and state mandates is adhered to at all times.
Promote effective and efficient utilization of all clinical resources and makes necessary recommendations for improvements to management as needed.
Ensure all client relationships are maintained and all client specific requirements are met.
Assist promptly in resolution of any physician and/or customer complaints or quality assurance issues.
Delegate work as needed and provide backup to all departmental positions as required.
Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures.
Participate in the development and implementation of policies and procedures in order to promote and achieve the most efficient operation possible.
Participate in various educational and or training activities as required.
Perform other duties as assigned.
Carrying out all responsibilities in accordance with the company’s standards, policies, and all applicable employment laws.
Managing and monitoring workflow and providing support, training, and techniques to assist staff in achieving department daily/weekly/monthly goals and standards.
Encouraging positive morale, maintaining harmony among staff, and resolving grievances when necessary.
Overseeing the completion and approval of employee timecards and coordinating overtime needs with management and staff as needed.
Actively participating in the department’s staffing requirements including hiring, onboarding, and separating of employees
In conjunction with management, creating and implementing plan to meet department’s goals and metrics based on workload and client needs.
Communicating change effectively and supporting those affected by change.
Supervising insubordinate staff when warranted and initiating coaching or corrective actions as required and/or directed by upper management.
Evaluating staff needs and performance, providing periodic feedback to staff and reporting any performance concerns and/or recommendations growth opportunities to management.
Actively participating and successfully conducting annual performance evaluations.