Quality Assurance Coordinator (31396)

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.

• 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.
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• 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.
• 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 maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.

NYRC is one of Canada's leading providers of independent medical assessments for a reason: your goal is our goal. At NYRC we provide services to the legal community as well as insurers and employers. In the medical-legal sector whether its liability, medical malpractice, plaintiff or defense counsel, we provide unbiased medical reports across the entire spectrum. In the employment and insurance sector we assist in facilitating healthy employees and satisfied plan members through timely diagnosis, pro-active objective treatment recommendations, and most importantly, evidentiary opinion on return to work.

NYRC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin.