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Quality Assurance Specialist

2 months ago

Austin, Texas, United States TMF Health Quality Institute Full time
Application Instructions:

Ensure your application is comprehensive, including details of your educational background, work history, and any relevant sections. The initial evaluation will focus on the minimum qualifications outlined in the job listing, such as educational credentials, professional experience, licenses, and certifications. Your application should reflect the necessary knowledge, skills, and abilities for this position. Incomplete submissions will not be considered.

*This position is remote within the United States*

Role Overview:

The Quality Assurance Specialist will engage in advanced quality assurance tasks. This role is crucial in ensuring that decision-makers accurately resolve disputes by conducting quality audits, reviewing processes, and disseminating audit findings. The Specialist will also facilitate meetings, provide coaching, and deliver training on quality standards. This position operates with a degree of autonomy, allowing for significant initiative and independent judgment.

Key Responsibilities:
  • Manage, strategize, and oversee the quality assurance program.
  • Conduct audits to guarantee the timeliness, accuracy, and consistency of dispute resolution outcomes.
  • Identify and develop training opportunities based on audit results and data analysis to enhance both individual and organizational quality.
  • Analyze data to detect issues, trends, and opportunities for improvement.
  • Review reopened cases and entries from the problem log to identify trends and areas needing enhancement.
Qualifications:

Education:
  • Associate's degree or 60+ credit hours towards a Bachelor's degree from an accredited institution in healthcare or a related field.
  • Relevant Medicare appeals or clinical experience in a healthcare environment may substitute for the Associate's degree on a year-for-year basis.
Experience:
  • A minimum of five (5) years in medical dispute resolution, Medicare appeals, or clinical experience within a healthcare setting.
  • At least two (2) years of training experience.
  • Demonstrated quality assurance experience.
  • Healthcare professional with proven experience in making medical necessity determinations.
  • Experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy.
Benefits:

TMF Health Quality Institute offers a comprehensive benefits package, which includes:
  • Medical, dental, vision, life, and disability insurance.
  • 401K plan.
  • Competitive salary.
  • Reimbursement for licenses and credentials.
  • Tuition reimbursement.
Equal Opportunity Employment:

We are an Equal Opportunity Employer and welcome applications from all qualified individuals, including minorities, females, veterans, and individuals with disabilities.