QA Specialist

Employment Type: PRN, As-needed

Location Type: Remote

Shifts Available: Days, Weekends, Evenings

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Position Overview

The QA Specialist is a crucial member of the review process, responsible for ensuring the timely and complete delivery of reviewer reports. This role involves direct communication with customers, reviewers, and management to meet customer-requested due dates. The QA Specialist ensures reports meet customer requirements, company best practices, and clinical accuracy standards. They also contribute to process improvement initiatives and collaborate with management to achieve high efficiencies. Dane Street's success is driven by individual and team contributions, fostering a positive environment that promotes client satisfaction and results.

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Major Duties & Responsibilities

Client Interaction

• Provide regular report status updates to clients.
• Evaluate the quality of physician reports, ensuring they meet all client and jurisdictional standards.
• Verify that the clinical rationale supports the physician's determinations.
• Clarify ambiguous report questions with clients.
• Distribute final reports to clients according to their specific requirements.
• Receive, coordinate, and execute all aspects of clarification and addendum requests from clients.
• Participate in calls or meetings with clients when a report is in question.
• Follow up with clients for any missing information pertinent to the referral.

Physician Interaction

• Work directly with physicians to ensure all client questions are answered and supported by clinical rationale.
• Conduct regular follow-ups with physicians or their office staff to ensure on-time report delivery.
• Compose and provide verbal or written feedback to physicians regarding report quality.
• Compose and provide verbal or written requests to physicians or their office staff for clarifications.
• Receive written or verbal confirmation from physicians that a report has their approval and ensure their signature for the final report.

Report Analysis

• Review each physician report for data accuracy, including spelling, grammar, and punctuation.
• Ensure all state requirements for reporting are met.
• Maintain report formatting and adhere to each client's specific requirements.
• Ensure all client special handling instructions regarding report completion and delivery are met.

Additional Duties

• May provide oversight to the work of team members.
• Continuously improve processes to facilitate better turnaround time, increase peer-to-peer success rates, and reduce reports returned by clients for clarification, ultimately enhancing client satisfaction.
• Responsible for the final approval of cases for release to the client.
• Act as a liaison and coordinate quality issue reports and new reviewer reports with the VP of Clinical Operations.
• Perform other duties and special projects as assigned based on business needs.

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Requirements

Education/Credentials

• An Associate’s Degree or Bachelor’s Degree is preferred.

Job Relevant Experience

• Business experience in a healthcare and/or insurance setting is preferred.

Job Related Skills/Competencies

• Exceptional communication skills with a clear understanding of company business lines.
• Ability to apply critical thinking, manage time efficiently, and meet specific deadlines.
• Computer literacy and typing skills are essential.

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Working Conditions/Physical Demands

• (Details regarding lifting, bending, traveling, etc., if applicable, would be listed here.)