Quality Coordinator

Remote, Anywhere USA • Austin, TX

2d • Remote

About The Position

The Quality Coordinator ensures decision makers adjudicate cases accurately by conducting quality audits and reviews, publishing audit results, and holding meetings, coaching, and training on quality. This position is remote and may require obtaining and maintaining a federal public trust security clearance because the employer is a federal contractor.

The coordinator audits reconsideration and dispute resolution decisions for timeliness, accuracy, and consistency; examines case files for inaccuracies and non-compliance; and analyzes data to identify improvements in the appeals process and reduce unnecessary appeals. The role also supports process and program improvement meetings, plans and delivers training for new and current staff, and shares educational feedback, trends, and insights with staff.

Requirements

• Associate's degree or at least 60 credit hours toward a bachelor's degree from an accredited college or university in healthcare or a related discipline. Additional Medicare appeals or clinical experience in a healthcare setting may substitute for the associate's degree on a year-for-year basis.
• Three years of medical dispute, Medicare appeals, or clinical experience in a healthcare setting.
• Two years of training Quality Healthcare Professional experience, with demonstrated experience writing or making medical necessity decisions.
• Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy experience.
• Have resided in the United States for at least three of the last five years, per contract requirement.
• Applications must include complete education, employment history, and other applicable sections.

Responsibilities

• Perform audits to ensure timeliness, accuracy, and consistency in reconsideration and dispute resolution decisions.
• Participate in planning, preparing, and facilitating regularly scheduled process and program improvement meetings.
• Oversee and plan training for new and current staff, including developing and presenting presentations, quality tips, and decision consistency memos.
• Perform audits and examinations of case files to identify inaccuracies and non-compliance issues.
• Share educational feedback, trends, and insights individually and collectively with staff.
• Analyze data to identify improvement opportunities in the appeals process and reduce unnecessary appeals.
• Participate in special projects and perform other duties as assigned.

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short- and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree