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Medical QA Specialist I

Company: QTC Management, Inc.
Location: Nashville
Posted on: October 13, 2021

Job Description:

Job Summary:

Under close supervision, performs a variety of activities to ensure accuracy and completeness of medical documentation and evaluation processes through the various training phases. Reviews and develops information for processes and diagnosis based on training and knowledge of medical processes and procedures performed. Tracks and controls non-conformance documents, reviews anomalies and contacts medical professionals for clarification with Quality Specialist. Reviews final documentation for accuracy and obtains finalization from medical professionals.

Essential Duties and Responsibilities:

  • Must be able to work Alternative Work Week Schedule (Wed–Sun 8:00AM – 4:30PM PST).
  • Responsible for satisfactory completion of QTC Medical Quality Assurance Training Program
  • Provide quality assurance for general medical and specialty examination reports
  • Responsible for the timeliness and quality of medical reports
  • Interface with physicians and healthcare extenders and provide case specific feedback as necessary
  • Meet personal productivity and quality goals
  • Other projects and duties as assigned

Competencies:

  • Working knowledge and understanding of medical terminology, anatomy and physiology
  • 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
  • Working computer skills
  • Proven analytical skills
  • Must possess the ability and flexibility to work early morning,  evening, and/or weekend shifts

Education and/or Experience:

  • High School diploma, or equivalent (GED)
  • Vocational 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.)
  • 0 to 1 year of experience in healthcare, medical, or insurance related industries
  • 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
  • Must be able to successfully pass National Agency Check with Inquiries (NACI) background investigation

This job description supersedes all prior job descriptions and is intended to describe the general content and essential requirements for the position listed above. It is not to be construed as an exhaustive statement of requirements, duties and responsibilities. Management reserves the right to add or change the duties of this position as required at any time.

QTC Management Inc. is a VEVRAA Federal contractor and an Equal Opportunity Employer. The company has an ongoing commitment to affirmative action and the creation of a workplace free of discrimination, harassment and retaliation. The company recruits, hires, trains, and promotes individuals in all job titles without regard to race, color, creed, religion, ancestry, national origin, age, sex, sexual orientation, people with disabilities protected under law, and  protected veteran status.

Experience

Required
  • Experience with case management software, electronic medical records and medical databases
  • 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
  • Less than 1 year(s): Healthcare, medical, or insurance related industry experience

Education

Required
  • GED or better
  • High School Diploma or better
Preferred
  • Technical/other training or better in HM Navy Medic
  • Technical/other training or better in Army Practical Nursing
  • Technical/other training or better in Vocational Nursing
  • Technical/other training or better in Combat Medic
  • Technical/other training or better in Medical Assistant
  • Foreign Medical Graduate or better
  • Corpsman or better

Skills

Required
  • Verbal Communication
  • Team Player
  • Medical Documentation
  • Human Anatomy/Physiology
  • Computer Literacy
  • Written Communication
  • MS Office
  • Medical Terminology
Preferred
  • Organization
  • Multi-line phone
  • Interpersonal
  • Executing Multiple Tasks
  • Customer Service
  • Analytical
  • Review Medical Reports/Evaluations
  • Sense of Urgency
  • Electronic Medical Records

Behaviors

Preferred
  • Team Player: Works well as a member of a group
  • Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

Motivations

Preferred
  • Job Security: Inspired to perform well by the knowledge that your job is safe
  • Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
  • Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
  • Goal Completion: Inspired to perform well by the completion of tasks

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)

Keywords: QTC Management, Inc., Nashville , Medical QA Specialist I, Other , Nashville, Tennessee

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