Quality Coordinator

Position Purpose :

Performs advanced (senior-level) quality assurance work. Ensures decision makers adjudicate disputes accurately by performing quality audits, reviews, and publishing audit results and conducting meetings, providing coaching, and training on quality. Works under limited supervision, with considerable latitude for the use of initiative and independent judgement.

Essential Responsibilities :

• Performs audits to ensure timeliness, accuracy, and consistency in reconsideration / dispute resolution decisions.
• Participates in planning, preparing, and facilitating discussion for regularly scheduled process and program improvement meetings.
• Oversees, provides and plans training for new and current staff, including developing and presenting presentations, quality tips, and decision consistency memos.
• Participates in special projects and performs other duties as assigned.
• Performs audits and examinations of case files to identify inaccuracies and non-compliance issues.

Minimum Qualifications

Education

• Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline

Additional Medicare appeals or clinical experience in a healthcare setting may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience

• Five (5) years medical dispute, Medicare appeals or clinical experience in a healthcare setting
• Two (2) years of training
• Quality experience
• Healthcare Professional with demonstrated experience writing or making medical necessity decisions
• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience

Benefits

C2C offers an excellent benefits package, including :

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License / credentials reimbursement
• Tuition Reimbursement

EOE Minorities / Females / Vet / Disability

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)