Clinical Quality Assurance Coordinator -- ExamWorks -- Rockland, IL

Contact Mike Foster at mike.foster@rightthinginc.com for more information!!

ExamWorks is a dynamic, fast growing global industry pioneer in the health care services sector. Our size, scale and service capabilities, combined with management's vision are transforming the IME industry. We are convinced that the high growth environment, the largest global geographic footprint and most advanced IT platform available differentiates ExamWorks from other IME companies. The company's mission is to rely on the local professional presence, enhance quality of service and improve workflow in the independent medical review process.
ExamWorks offers exceptional career growth opportunities, a competitive compensation plan, complete benefits package and financial incentive programs. We encourage you to consider this opportunity.

Essential Duties and Responsibilities

• Evaluates clinical information received, writes and/or reviews  various reports including Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements
• Performs quality assurance review of peer review reports, correspondences, addendums or supplemental 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
• In IME or Peer Review cases, ensures 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
• Contacts appropriate person to recover any missing documentation or verify charges
• 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 continuing education requirements and or training activities
• Perform other duties as assigned.

Key Qualifications

• Bachelor degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience. Experience with medical terminology, medications, medical specialties and treatment protocols required. Experience in the insurance industry preferred 
• Must hold and maintain an unencumbered Registered Nursing license 
• Must have strong knowledge of medical terminology, anatomy and physiology, treatment protocols, 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 
• * Ability to follow instructions and respond to upper managements' directions accurately 
• * 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 
• Must be able to demonstrate and promote a positive team -oriented environment 
• Must be able to stay focused and concentrate with frequent interruptions 
• Must be able to work well under pressure and or stressful conditions 
• Must possess the ability to manage change, delays, or unexpected events appropriately 
• Demonstrates reliability and abides by the company attendance policy 
• Must maintain a professional and clean appearance at all times consistent with company standards 
• Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements 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 clients, physicians, upper management, regulatory agencies, and/or members of the business community
• Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.