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Quality Coordinator
1 month ago
**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.***This position is located Remote United States*Position Purpose:Performs advanced (senior-level) quality assurance work. Ensures decision makers adjudicate disputes accurately by performing quality audits, reviews, and publishing audit results and conducting meetings, providing coaching, and training on quality. Works under limited supervision, with considerable latitude for the use of initiative and independent judgement.Essential Responsibilities:Oversees, plans, and monitors the quality assurance program.Oversees, plans, and audits to ensure timeliness, accuracy, and consistency in reconsideration/dispute resolution decisions.Oversees, develops, and identifies individual and collective training opportunities based on audit findings and/or data analysis of reconsiderations/dispute resolution decisions to help improve individual and corporate quality.Oversees, plans, prepares, reviews and analyses data to identify problems, trends and improvement opportunities.Oversees, plans, and reviews reopened cases and cases from the problem log in order to identify trends and needs for improvement.Minimum QualificationsEducationAssociate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related disciplineAdditional Medicare appeals or clinical experience in a healthcare setting may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)ExperienceFive (5) years medical dispute, Medicare appeals or clinical experience in a healthcare settingTwo (2) years of trainingQuality experienceHealthcare Professional with demonstrated experience writing or making medical necessity decisionsNursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experienceBenefitsC2C offers an excellent benefits package, including:Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insuranceSection 125 plan401KCompetitive salaryLicense/credentials reimbursementTuition ReimbursementEOE Minorities/Females/Vet/DisabilityEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
