IME QA Specialist - Ethos Risk Services

Job Description

The IME QA Specialist is responsible for ensuring case reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and /or federal and state mandates.

Responsibilities

· Performs quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews.

· Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.

· Ensures that all client instructions and specifications have been followed and that all questions have been addressed.

· Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.

· Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.

· Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.

· Verifies that the reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.

· Ensures the provider credentials and signature are adhered to the final report.

· Identifies any inconsistencies within the report and contacts the Reviewer to obtain clarification, modification or correction as needed.

· Assists in resolution of customer complaints and quality assurance issues as needed.

· Adhere to all deadlines and state statutes.

· Adhere to Ethos Policies and Procedures as appropriate to job functions.

· Assists in promoting and furthering the objectives of the IME Division.

· Maintains confidentiality and security in all aspects of performance.

· Performs other related duties incidental to the work described herein.

Education

· High school diploma or equivalent required.

· Associate or bachelor's degree preferred.

Experience

· 1 to 3 years of experience in the medical management field.

· Healthcare or medical administrative experience preferred.

Skills

· Excellent customer service skills.

· Strong oral and written communication skills.

· Computer knowledge required, including Microsoft Office products.

· Able to perform as part of a team.

· Strong organizational skills.

· Excellent interpersonal skills.

· Discretion and confidentiality.

· Ability to multi-task.

LICENCES/CERTIFICATIONS/INSURANCE

· LPN, LVN or RN preferred.

WORKING CONDITIONS:

This position works in an office environment where temperatures are constant. Frequent prolonged periods of a stationary position. Constant operation of a computer and other office productivity machinery, such as a calculator, copy machine/printer. Frequent communication via telephone and in person with clients, customers, and co-workers.

Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic protected by law.

A background check will be conducted, in accordance to the local state law and regulations.