Jobs
>
Rockford

    clinical quality assurance coordinator - Rockford, IL , USA, United States - ExamWorks

    ExamWorks
    ExamWorks Rockford, IL , USA, United States

    5 days ago

    Default job background
    Description
    Overview

    Are you looking for a position that is challenging, will keep your clinical skills sharp, but doing so from the comfort of home?


    ExamWorks is seeking a self-motivated, high-performing nurse (RN) to join our team as a Clinical Quality Assurance Coordinator CPC or CPC-A Certification is required.

    This position is 100% remote and the schedule will be Monday-Friday, 8:00am-4:30pm CT.


    The Clinical Quality Assurance Coordinator is responsible for performing quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.

    This teams work is billing/coding appeal level reviews so you'll use your certification to review files and make determinations.

    Are you motivated, energetic, and excited to become part of the ExamWorks team? If so, you might be our next new team member

    Responsibilities


    • Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
    • Billing / coding appeal level reviews.
    • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
    • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
    • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
    • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
    • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
    • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
    • Ensures the provider credentials and signature are adhered to the final report.
    • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
    • Assists in resolution of customer complaints and quality assurance issues as needed.
    • Ensures all federal ERISA and/or state mandates are adhered to at all times.
    • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
    • Promote effective and efficient utilization of company resources.
    • Participate in various educational and or training activities as required.
    • Perform other duties as assigned.
    Qualifications

    High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience.

    Knowledge of the insurance industry preferably claims management relative to one or more of the following categories:
    workers' compensation, no-fault, liability, and/or disability.


    • CPC Certified
    • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
    • Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
    • Must be a qualified typist with a minimum of 40 W.P.M
    • 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 possess excellent skills in English usage, grammar, punctuation and style.
    • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
    • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
    • Must be able to work independently, prioritize work activities and use time efficiently.
    • Must be able to maintain confidentiality.


    ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services.

    Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

    ExamWorks offers a fast-paced team atmosphere with competitive benefits, paid time off, and 401k.


    ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

    Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
  • ExamWorks

    Quality Assurance Coordinator

    1 week ago

    ExamWorks Rockford, United States

    Overview: · Are you an MA (Medical Assistant) looking to step away from a medical office and into a remote position? · If you answered yes, then this might be the job for you because ExamWorks is looking for a Quality Assurance Coordinator for our team. You will be responsible ...

  • ExamWorks

    clinical quality assurance coordinator

    4 days ago

    ExamWorks Rockford, IL , USA, United States

    Overview · Are you an experienced Licensed Practical Nurse (LPN or LVN) looking for your next opportunity? · ExamWorks is seeking a Clinical Quality Assurance Coordinator to join our team · This position is 100% remote and the schedule will be Monday - Friday 9:00am to 5:30pm CT. ...

  • ExamWorks

    clinical quality assurance coordinator

    3 days ago

    ExamWorks Rockford, IL , USA, United States

    Overview · Are you an experienced Licensed Practical Nurse (LPN or LVN) looking for your next opportunity? · ExamWorks is seeking a Clinical Quality Assurance Coordinator to join our team · This position is 100% remote and the schedule will be Monday - Friday 9:00am to 5:30pm CT ...

  • ExamWorks

    clinical quality assurance coordinator

    3 days ago

    ExamWorks Rockford, IL , USA, United States

    Overview · Calling all Weekend Warrior Nurses from Across the U.S. · Are you looking for a position that is challenging, will keep your clinical skills sharp, but doing so from the comfort of home? · ExamWorks is seeking a self-motivated, high-performing nurse (LPN/LVN or RN) to ...

  • ExamWorks

    clinical quality assurance coordinator

    6 days ago

    ExamWorks Rockford, IL , USA, United States

    Overview · Are you looking for a position that is challenging, will keep your clinical skills sharp, but doing so from the comfort of home? · ExamWorks is seeking a self-motivated, high-performing nurse (RN or LPN/LVN) to join our team. · The Clinical Quality Assurance Coordinato ...

  • ExamWorks

    clinical quality assurance coordinator

    6 days ago

    ExamWorks Rockford, IL , USA, United States

    Overview · Are you looking for a position that is challenging, will keep your clinical skills sharp, but doing so from the comfort of home? · ExamWorks is seeking a self-motivated, high-performing nurse (RN) to join our team. · The Clinical Quality Assurance Coordinator is respon ...

  • ExamWorks

    Clinical Quality Assurance Coordinator

    6 days ago

    ExamWorks Rockford, United States

    Overview: · Are you looking for a position that is challenging, will keep your clinical skills sharp, but doing so from the comfort of home? · ExamWorks is seeking a self-motivated, high-performing nurse (LPN/LVN) to join our team. · The Clinical Quality Assurance Coordinator ...

  • Forest City Rehab and Nursing Center

    Psychiatric Rehabilitation Services Coordinator

    4 days ago

    Forest City Rehab and Nursing Center Rockford, United States

    **QUALIFICATION**: · A Psychiatric Rehabilitation Services Coordinator (PRSC) shall possess a bachelor's degree. · Working Conditions and Qualifications · Ability to establish working relationships with residents, family members, staff, visitors, government agency personnel, etc. ...

  • European Service at Home, Inc

    Care Coordinator

    5 days ago

    European Service at Home, Inc Rockford, United States

    **Be a Hero and Make a Difference for the Elderly With Your Work** · European Service at Home, an Illinois leader of In-Home Services, is currently searching for a committed Case Coordinator - at our local Rockford office. · **WAGE**: · - $21- 23 per hour (Based on Experience) · ...

  • PA Peterson at the Citadel

    Scheduling Coordinator

    1 week ago

    PA Peterson at the Citadel Rockford, United States

    **PA Peterson requires all staff to be vaccinated for COVID-19** · **SCHEDULING COORDINATOR** · Pa Peterson at the Citadel is currently seeking an experienced Scheduling Coordinator to join our team. The primary purpose of the Scheduling Coordinator is to ensure adequate and appr ...

  • Examworks Group, Inc.

    Client Coordinator Trainer

    1 week ago

    Examworks Group, Inc. Rockford, United States

    Overview: · ExamWorks is seeking a **Client Coordinator - Trainer.** · The Client Coordinator Trainer is responsible for servicing inquiries from clients, physicians, nurses or any representative acting on behalf of a client. This position performs a wide range of data processing ...

  • Veterans Assistance Commission of Winnebago County

    Administrative Assistant

    2 days ago

    Veterans Assistance Commission of Winnebago County Rockford, United States

    **JOB SUMMARY**: · Under the supervision of the Superintendent and the Executive Assistant. This position requires a confident, secure, intelligent, public speaker, with a positive attitude that fully understands and embraces the VACWC mission and embraces the fact they are the f ...

  • Examworks Group, Inc.

    Client Coordinator

    5 days ago

    Examworks Group, Inc. Rockford, United States

    Overview: · The Client Coordinator is responsible for servicing inquiries from clients, physicians, nurses or any representative acting on behalf of a client. This position performs a wide range of data processing tasks, including data preparation, data entry, data tracking, docu ...

  • Leisure Living

    Wellness Director

    3 days ago

    Leisure Living Rockford, United States

    **Wellness Director** · **Boulder Creek Assisted Living & Memory Care** · *** · Responsible to plan, organize, develop and direct the operations of the Care Department in accordance with current federal, state and local regulations. · **ESSENTIAL FUNCTIONS** · - Foster positive w ...

  • Apex Dynamics

    Civil engineer

    1 week ago

    Apex Dynamics Winnebago, United States

    We are a young and dynamic engineering office, always on the lookout for solution-oriented and motivated individuals who want to make a difference. · Your responsibilities · Implementation of exciting projects in the field of renovation, energy-efficient renovation, historic pres ...

  • Harrison Consulting Solutions

    Resident Engineer

    2 days ago

    Harrison Consulting Solutions Rockford, United States

    Growing Chicago firm is looking to add a Resident Engineer for their Rockford, Illinois area team · Responsibilities: · Supervise construction on highway and/or roadway projects throughout areas of Illinois · Provide quality assurance to projects comply with plans/specifications ...

  • Professional Plastics

    Quality Control Inspector Lead

    1 week ago

    Professional Plastics Loves Park, United States

    Professional Plastics is a leading distributor of high-performance engineering plastic shapes. We provide the widest range of engineering plastics, composites & technical ceramics in the marketplace. Established in 1984, Professional Plastics has grown to 22 locations across the ...

  • IMI Precision Engineering

    Supply Chain Manager

    2 days ago

    IMI Precision Engineering Machesney Park, United States

    **IMI plc** · IMI plc is a sector focused organisation at the forefront of delivering motion and fluid control technologies that create a more sustainable world, improving the quality of life for our customers and communities and ultimately delivering our purpose of Breakthrough ...

  • Corrugated Metals

    Safety Coordinator

    2 days ago

    Corrugated Metals Belvidere, United States

    Corrugated Metals, Inc., a leading manufacturer of roll formed metal products, is seeking a Safety Coordinator. This position is responsible for managing the assurance of the company's quality for all products, both purchased and manufactured, overseeing, implementing and leading ...

  • Allied Universal®

    Security Account Manager

    1 week ago

    Allied Universal® Janesville, United States

    Security Account Manager · **Overview**: · Allied Universal, North America's leading security and facility services company, provides rewarding careers that give you a sense of purpose. While working in a dynamic, diverse and inclusive workplace, you will be part of a team that f ...