Quality Coordinator

Job Summary

Working remotely, the full-time Quality Coordinator will ensure accurate adjudication of cases by performing quality audits, facilitating process improvement meetings, and providing training for staff.

Key responsibilities

• Perform audits to ensure timeliness, accuracy, and consistency in dispute resolution decisions
• Plan and facilitate discussions for process and program improvement meetings
• Develop and present training materials, including quality tips and decision consistency memos

Required qualifications

• Associate's degree or 60 credit hours towards a Bachelor's degree in healthcare or related discipline
• Three years of medical dispute, Medicare appeals, or clinical experience in a healthcare setting
• Two years of training experience
• Experience in Managed Care or as a healthcare professional making medical necessity decisions
• Preferred experience in Medicare Part C related appeals activities