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Quality Review Specialist

Quality Review Specialist

QsourceMemphis, TN, US
15 days ago
Job type
  • Full-time
Job description

Job Summary

The Quality Review Specialist is responsible for quality assurance and utilization review of medical records and Patient-Centered Service Plans, preparation and review of audit reports. The Quality Record Review Specialist also provides general support for all EQR programs as needed.

Essential Duties and Responsibilities

  • Provide a detail-focused review of clinical documentation to ensure quality regulatory compliance and audit readiness.
  • Detail-focused review of enrollee care plans for compliance with standards and appropriateness.
  • Assist in aggregating results for reporting and report review.
  • Maintain HIPPA / Security Training requirements.
  • Review Medical & Dental records and claims data for completeness and accuracy of CDT / CPT codes.
  • Provide general support for all EQRO contracts as needed.
  • Additional duties as requested by the EQRO Director.

Knowledge, Skills & Abilities

  • Proficient computer skills (MS Word, Excel, PowerPoint).
  • Excellent oral, written, and customer service-oriented communication skills.
  • Excellent and demonstrated criticalthinking ability.
  • Excellent organizational skills with the ability to respond to and coordinate multiple activities simultaneously under short time frames.
  • Customer service oriented when working with internaland external customers.

    • Education, Experience, & Licensing Requirements

    Education

  • High School diploma or equivalent required.

    • Experience

  • One (1) to Three (3) years of Medicaid or Managed Care documentation and audit experience preferred.

    • Travel Requirements

  • Employee will work remotely from a home-based office. Approximately 25% travel is required.

    • Physical Requirements

    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.

  • Employee will constantly communicate with others regarding employment related information or instruction and must be able to exchange accurate information in these situations.
  • This role requires constant use of standard office equipment such as computers and telephones to receive and share information.
  • Employee must be able to read and interpret information displayed on a computer screen.
  • Employee must be able to remain in a stationary position for extended periods of time.
  • This role occasionally requires the employee to lift light objects up to 25 pounds.
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    Quality Review Specialist • Memphis, TN, US