Physician Advisory Services Clinical QA Specialist

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Requirements:

• An Active Registered Nurse License is required.
• A Bachelor’s Degree is preferred.
• Business experience in a healthcare and/or insurance setting is preferred.
• Exceptional communication skills with a clear understanding of company business lines.
• Ability to apply critical thinking and manage time efficiently.
• Computer literacy and typing skills are essential.

Responsibilities:

• Provide regular report status updates to clients.
• Evaluate the quality of physician’s reports for client and jurisdictional standards.
• Clarify ambiguous report questions with clients.
• Distribute final reports to clients as per specifications.
• Coordinate clarification and addendum requests from clients.
• Engage in phone calls or meetings with clients regarding report inquiries.
• Follow up with clients for any missing referral information.
• Collaborate with physicians to address client questions with clinical rationale.
• Ensure timely report delivery through regular follow-ups with physicians.
• Provide feedback to physicians on report quality.
• Receive confirmation and signatures from physicians on reports.
• Review physician reports for accuracy and adherence to state requirements.
• Ensure client special handling instructions are met.
• Maintain oversight of complex cases needing additional review.
• Act as additional QA for cases with quality issues.
• Oversee the work of team members where applicable.
• Continuously improve processes for quicker turnaround and higher client satisfaction.
• Provide final case approvals before release to clients.
• Coordinate quality issue reports with the VP of Clinical Operations.
• Handle other duties and special projects as assigned.