Overview
Quality Supervisor Jobs in Santa Teresa, NM at Admiral Cable, Inc.
SUMMARY
The Quality Assurance Coordinator is responsible to ensure reports are completed at the highest level of quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is required to handle quality assurance questions and provide overall support to the Quality Assurance Department.
ESSENTIAL JOB FUNCTIONS
Perform quality assurance review of reports, correspondences, addendums or supplemental reviews.
Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
Ensure that all client instructions and specifications have been followed and that all questions have been addressed.
Ensure 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.
Ensure 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.
Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.
Ensure the provider credentials and signature are adhered to the final report.
Identify any inconsistencies within the report and contact the Provider to obtain clarification, modification or correction as needed.
Assist in resolution of customer complaints and quality assurance issues as needed.
Ensure all federal ERISA and/or state mandates are adhered to at all times.
Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
Promote effective and efficient utilization of company resources.
Participate in various educational and or training activities as required.
Perform other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS
Education and/or Experience
High school diploma or equivalent required. Two years IME or medical experience preferred. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers’ compensation, no-fault, liability, and/or disability preferred.
Certificates, Licenses, Registrations
No specific requirements.
ESSENTIAL COMPETENCIES
QUALIFICATIONS
Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
Must be a qualified typist with a minimum of 40 W.P.M preferred.
Must be able to operate a general computer, fax, copier, scanner, and telephone.
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
Must possess excellent skills in English usage, grammar, punctuation and style.
Ability to follow instructions and respond to upper managements directions accurately.
Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
Must be able to work independently, prioritize work activities and use time efficiently.
Must be able to maintain confidentiality.
Must be able to demonstrate and promote a positive team -oriented environment.
Must be able to stay focused and concentrate under normal or heavy distractions.
Must be able to work well under pressure and or stressful conditions and must possess the ability to manage change, delays, or unexpected events appropriately.
Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
LANGUAGE /COMMUNICATION SKILLS
Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements and/or legal contracts and documents.
Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.
Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This is generally a sedentary job position that consists of:
Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs.
Ability to operate a computer up to 4 hours at a time.
Ability to travel to different floors of the office or other locations.
Ability to move throughout the office.
Occasionally lifting and/or carrying up to 10 lbs.
Occasionally pushing/pulling up to 10 lbs.
Occasionally subject to bending, squatting or twisting.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Weekend work and/or extended hours are occasionally required beyond the regular eight (8) hour work day.
The noise level in the work environment is usually moderate.
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Title: Quality Supervisor
Company: Admiral Cable, Inc.
Location: Santa Teresa, NM
