Clinical Quality Analyst

JOB SUMMARY

The Clinical Quality Analyst plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is delivered by the customer requested due date.

In addition to the duties of the Quality Analyst, the Clinical Quality Analyst is also responsible for ensuring that the clinical content is accurate and adequate and serves as a resource for the QAs who are not medically trained when they have questions about medical content.

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other, and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

Report Analysis

• Review each physician report for data accuracy including spelling, grammar & punctuation.
• Responsible for ensuring that all state requirements for reporting are met.
• Responsible for report format and adhering to each client’s specific requirements.
• Must ensure that all client special handling instructions with regard to report completion and delivery are met.
• Timely delivery of the final report
• Responsible for escalating any occurrence, per referral, that falls outside of previously established customer, company, or departmental requirements to the appropriate entity.
• Responsible for following all previously established customer, company, and departmental escalation procedures.

Communication

• Communicates with reviewers, customers, and internal employees, verbally and via email, professionally in compliance with all established formats and policies.
• Clinical Duties
• Performs an independent analysis of a claimant’s medical records (“Nurse Review”) for our clients when requested.
• Serves as an additional level of QA for cases with Quality Issues.
• Physician Interaction
• Works directly with physicians to ensure that all client questions are answered and supported by clinical rationale.
• Conduct regular follow-up with the physician or their office staff to ensure on-time delivery of the report.
• Compose and provide verbal or written feedback to the doctor regarding report quality.
• Compose and provide verbal or written requests to the physician or their office staff for clarifications.
• Receive written or verbal confirmation from the physician that a report has the doctor’s approval and that the doctor provides his/her signature for the final report.

Client Interaction

• Provides regular report status updates to the client.
• Evaluate the Quality of the physician’s report and determine if the report will meet all client and jurisdictional standards; the QA Specialist is also responsible for ensuring that the clinical rationale supports the physician’s determinations.
• Clarifies ambiguous report questions with clients.
• Follow up with the client for any missing information that is pertinent to the referral.

Additional Duties

• May provide oversight to the work of the team members.
• Provides remediation in training to existing QAs as well as ongoing education.
• Performs case assignments to QA contractors.
• Responsible for the final approval of cases for release to the client.

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:

-Active Registered Nurse

-Disability experience is preferred

- Diverse Clinical Background

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above.  Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services. 

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.

Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.

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