Quality Assurance Specialist - Level 1-3

Location: Gaithersburg, MD
Date Posted: 12-15-2017
DecisionPoint is actively seeking several qualified Quality Assurance candidates to support a large contract with the Department of Veterans Affairs, Veterans Benefits Administration (VBA).
Primary Duties and Responsibilities
· Provide quality assurance and careful review of examination reports for general medical and specialty exams to ensure reports are complete, consistent, and clear.
· Tracks and controls non-conformance documents, reviews anomalies and contacts medical professionals for clarification.
· Reviews final documentation for accuracy and obtains finalization from medical professionals.
· Responsible for the contractual timelines for productivity and quality of medical reports
· Interface with physicians and healthcare providers and provide case specific feedback as necessary
· Responsible for obtaining timely receipt of completed, signed DBQs and all related diagnostics.
· Ensure providers have reviewed and considered all Diagnostic Test results as part of the exam evaluation and that these are referenced in the final report.
· Submits completed and validate exam documents to Billing QA for review and final submission to the VA.
· Monitor age of all cases
· Review billing associated data
· Assist in researching Veteran complaints
· Ensure strict adherence to protecting all PII and PHI according to JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and other applicable regulations
· Other projects and duties as assigned
 
Education and/or Experience:
· Associates or Bachelor’s degree from an accredited college in a healthcare related field or equivalent experience/combined education
· Training in specific aspects of job functions and/or demonstrated ability to perform assigned tasks, preferably in a medical related area of study (i.e. LVN, LPN, EMT, MA, Military Medic, etc.).
· 2 - 7 years of experience in healthcare, medical, or insurance related industries is required.
· Direct healthcare experience in medical case management or quality assurance to include the review of complex multi-focal medical reports for quality, clarity, thoroughness and insightful medical explanation
· Experience with case management software, electronic medical records and medical databases
· Excellent working knowledge and understanding of medical terminology, anatomy and physiology
Competencies:
· Ability to work independently and with team members at all levels of the organization
· Excellent verbal and written communication skills
· Proven ability to organize, plan, coordinate and multi-task
· Able to work with a high sense of urgency and follow through while maintaining professional composure
· Ability to investigate, fact find and provide evidence towards case resolution
· Ability to train and mentor other employees.
· Excellent computer skills
· Proven analytical skills
· Ability to prioritize and perform functions at varying levels to ensure contract compliance
 
Determination of level is based on the combination of education and relevant experience:
Level 1 : 2-3 years
Level 2 : 4-5 years
Level 3 : 6+ years
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