Quality Assurance Specialist (Medical Report Reviewer)

Why Work for Us

Workplace well-being is more important than ever. We are the winner of theand 2024 Best and Brightest Companies to Work for In The Nation. We have also won the 2020 Best Places to Work Award Minneapolis/St. Paul Business Journal.

Our employees benefit from a competitive benefits package that includes paid time off (PTO) paid parental leave paid holidays insurance (medical dental vision life STD LTD) flexible schedules a 401k program with company match and profit sharing. Insurance benefits are effective on the 1st of the month following month of hire.

At R3 Continuum we believe our differences dont divide us but teach us. R3 Continuum eagerly embraces diversity and is a committed Equal Opportunity Employer to all qualified applicants ensuring individuals will not be discriminated against based on any protected classifications.

Join a company dedicated to helping people and organizations be more resilient and thrive.

Position Summary

Remote Full-time

8:30 AM CT - 5 PM CT

The Quality Assurance (QA) Specialist provides reviews and audits the work of the network panel (medical and behavioral health) on File Reviews and Evaluations services. The QA Specialist reviews their work for content opinion clarity and consistency and will ensure that all questions posed by the client are answered and that the answers contain appropriate rationale. The specialist will work directly with the network panel for revisions to reports and case documents as needed and will also facilitate any calls required between panelists on a case. The specialist will also be responsible for identifying and resolving network panelist quality issues.

Essential Functions (In order of importance) Approximate % of time required

QA Specialist 90%

Other 10%

Essential Functions

• Complete quality assurance reviews on each report (file reviews and evaluations) letter and appendix and provide clear and concise edits to the specialist ensuring that reports and case documents are error free and delivered on time to the customer
  • Review for consistency and clarity of content
  • Ensure network specialist answers all questions requested by customer
  • Review completeness of all reports letters and appendices ensuring that all customer instructions were followed by the network specialist
  • Identify potential clinical content inconsistencies and collaborate with Manager Quality Assurance and/or Clinical Subject Matter Experts as needed including clarification reports
• Facilitate and document panel calls between network specialists as needed
• Send letters to attending physicians via fax or mail
• Send finalized reports and case documents to customers
• Identify network panelist quality issues and resolve issues by providing feedback/training to the network panelist and if necessary referring the network panelist back to the Training Department based on available data
• Demonstrate proficiency in using eCase Manager (eCM) as it relates to QA tasks
• Document all communications with network specialists and work completed in eCM
• Monitor workload through use of eCM reports
• Maintain confidentiality utilizing HIPAA guidelines

Other Essential Functions

• Assist in gathering case documents for legal records requests as needed
• Participate in process improvement identification and solutions including completion of projects
• Participate in department and company meetings as requested
• Perform other duties as assigned
• Overtime/Additional Hours There are times in which overtime/additional hours will be mandatory due to an increase in work and the need to meet turnaround timeframes

• Ability to develop and foster relationships with employees network panelists and customers at all levels of the organization.
• Comfort and ability to give clear consistent and concise direction and communication with network panelists (RNs psychologists physicians) and team members.
• Good judgment with the ability to make timely and sound decisions based on data and business acumen
• Ability to recall important and commonly used QA concepts and to independently apply concepts learned to multiple areas
• Highly proficient with verbal and written communication
• Excellent grammar and spelling skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Ability to multitask and to quickly switch between two unrelated tasks
• Excellent time management skills with a proven ability to meet deadlines
• Strong analytical and problem-solving skills
• Ability to function well in a high-paced and at times stressful environment
• Proficient with Microsoft Office Suite or related software
• Basic mathematics skills

Education & Licensing

• Bachelors degree or higher preferably in a human or natural science from an accredited college or university preferred

Experience

• 1 to 3 years of previous experience reviewing reports with medical mental health and/or scientific content is preferred
• 1 to 3 years of previous experience working and communicating with medical professionals is preferred
• 1 to 3 years of previous experience in the disability or workers compensation insurance industry or similar is preferred

The starting pay range for this position is $20.50 - $22 per hour. The positions pay range represents the national average pay for similar roles. R3 considers factors such as (but not limited to) experience internal pay equity and other business considerations when extending an offer.

Employment contingent on a successful background check reference checks work verification and signing a non-disclosure agreement.

R3 Continuum is committed to providing reasonable accommodations to qualified individuals with disabilities in the employment application process. For individuals with disabilities who would like to request an accommodation please contact our Human Resources department at .