Clinical Quality Control Specialist
On-siteTexas, United States
Job Summary
Audit reports, analyze data, and identify industry trends to monitor and improve Physician Life Care Planning's products and services against established quality standards. Participate in protocol deviation and risk management reviews, administer quality assurance processes, and evolve the Future Medical Requirements Database. Provide guidance to experts and recommend workflow improvements to ensure system efficiency, while training associates on company methodologies. Identify systematic risks to senior management and propose mitigation strategies. Maintain compliance with company policies and American Academy of Physician Life Care Planners' best practices.
Required Qualifications
- Qualified and experienced Medical Paralegal or rehabilitation professional such as Registered Nurse, Physician Assistant, Physical Therapist, and Occupational Therapist
- Bachelor's Degree
- Minimum of 5 years clinical experience, preferably in a rehabilitation setting
- Current and in good standings with license and certification bodies
- Advanced knowledge of CPT, HCPCS, ICD-9-CM, ICD10-CM, and MS-DRG medical codes
- Advanced knowledge of medical terminology, anatomy and physiology, pharmacology, and surgical procedures
- Advanced knowledge of usual, customary, and reasonable fee data
- Broad knowledge of risk-based quality system approaches consistent with good clinical skills/life care planning methodology
- Working knowledge of good clinical practices
- Excellent verbal and written communication skills
- Ability to identify and/or resolve quality assurance issues with others in a proactive, diplomatic, flexible, and constructive manner
- Strong commitment to ethical integrity and objectivity
- Excellent critical thinking, analytical and organizational skills
- Strong attention to detail
- Demonstrated ability to work independently in a deadline-driven, multi-project environment
- After hours work and some weekends may be required to ensure deadlines are met
- Clinical Quality Assurance Specialists will adhere to all federal HIPAA laws and regulations and be willing to sign a confidentiality agreement
Desired Qualifications
- Familiarity with legal procedures related to personal injury cases
- Proficiency in internet research
- Advanced to Expert skill level in Microsoft Office (Outlook, Work, Excel, and One Note)
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