Clinical Quality Assurance Reviewer- REMOTE

A-Line Staffing is now hiring a Quality Assurance Reviewer.

Position Details

• Schedule: Monday–Friday, 11:30 AM–8:00 PM
• Pay Rate LPN: $24.00–$27.00 per hour
• Pay Rate RN: $29.00–$31.00 per hour
• Benefits: Active after 90 days

Responsibilities

• Conduct quality assurance reviews of peer review reports, correspondence, addendums, and supplemental reviews.
• Ensure reports contain clear, concise, evidence-based rationales supporting recommendations and determinations.
• Verify that client instructions, specifications, and required questions have been addressed.
• Review clinical citations and references when applicable, ensuring sources are current and from reputable medical journals or publications.
• Ensure reports meet company standards for content, formatting, accuracy, and professional appearance.
• Verify that the appropriate board specialty reviewed each case according to client specifications and applicable state mandates.
• Confirm provider credentials, signatures, and required attestations are accurately documented.
• Identify inconsistencies and work with Peer Reviewers to obtain clarification or corrections.
• Assist with client complaints and quality assurance issues as needed.
• Ensure compliance with applicable federal ERISA requirements and state mandates.
• Provide management with insight regarding consultant quality, availability, and compliance.
• Promote efficient use of company resources.
• Participate in required training and educational activities.
• Perform other duties as assigned.

Qualifications

• High School Diploma Required
• Previous experience in clinical documentation, medical records, quality assurance, medical claims, utilization review, appeals and grievances or peer review coordination
• Strong knowledge of medical terminology, anatomy and physiology, medications, and laboratory values.
• Typing speed of at least 40 WPM.
• Strong understanding of HIPAA regulations and confidentiality requirements.
• Proficiency with computers and office equipment, including fax machines, copiers, scanners, and telephones.
• Proficiency with Microsoft Word, Outlook, Excel, and Internet-based applications.
• Ability to remain focused and productive in a busy or high-pressure environment.
• Ability to adapt to changing priorities, delays, and unexpected situations.