Group Health QA Specialist

The QA Specialist plays an integral role in reviewing reports, communicating with clients and physicians, and ensuring report accuracy and compliance in a healthcare or insurance setting.

Location: United States

Responsibilities

• Provides regular report status updates to the client.
• Evaluates the quality of physician’s reports and determines if they meet client and jurisdictional standards.
• Clarifies ambiguous report questions with clients.
• Distributes final reports according to client requirements.
• Coordinates and executes clarification and addendum requests from clients.
• Participates in calls or meetings with clients regarding reports.
• Follows up with clients for missing information.
• Works directly with physicians to ensure questions are answered and supported by clinical rationale.
• Follows up with physicians to ensure timely report delivery.
• Provides feedback to physicians on report quality.
• Requests clarifications from physicians.
• Obtains physician approval and signature for final reports.
• Reviews physician reports for data accuracy, spelling, grammar, and punctuation.
• Ensures reports meet state requirements and client-specific formatting and handling instructions.
• May oversee team members’ work.
• Improves processes for better turnaround times, peer success, and client satisfaction.
• Provides final approval for case releases.
• Coordinates quality issues and new reviewer reports with VP of Clinical Operations.
• Performs other duties and special projects as needed.

Requirements

• An Associate’s Degree or Bachelor’s Degree is preferred.
• Business experience in healthcare and/or insurance setting is preferred.
• Exceptional communication skills and understanding of company business lines.
• Critical thinking, time management, and meeting deadlines.
• Computer literacy and typing skills.

Benefits

• Medical, dental, and vision coverage.
• Voluntary life insurance options for employee and family.
• Voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance.
• Basic life insurance, short-term and long-term disability at no cost.
• Paid time off.
• 401k plan with company match.
• Apple equipment and media stipend for remote workspace.