Quality Coordinator

Job Summary

Ensuring accurate case adjudication, the full-time Quality Coordinator will perform quality audits, facilitate training sessions, and lead process improvement meetings in a remote capacity while working weekends and rotating holidays as needed.

Key responsibilities

• Conduct audits to verify the timeliness and accuracy of dispute resolution decisions
• Plan and facilitate discussions for process and program improvement meetings
• Develop and present training materials for new and current staff on quality standards

Required qualifications

• Associate's degree or 60+ credit hours toward a Bachelor's degree in healthcare or related field
• 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 with Medicare Part C related appeals activities