QA Analyst Level III

Key Responsibilities

• Audit Clinical Reviews: Conduct in-depth audits of case reviews and calls to ensure compliance with healthcare regulations, patient safety, internal policies, communication, and documentation accuracy.
• Ensure Regulatory Compliance: Verify that all clinical review processes are adhering to all laws, regulations and industry standards.
• Identify Quality Improvement Opportunities: Analyze trends, detect inconsistencies, and recommend process enhancements to improve efficiency and patient outcomes.
• Provide Constructive Feedback: Deliver detailed reports and insights to clinical teams, assisting in corrective actions and training objectives.
• Collaborate with Cross-Functional Teams: Work closely with clinical reviewers, operations, and training teams to implement quality assurance strategies.
• Support Continuous Improvement: Participate in the development and refinement of quality assurance frameworks, audit methodologies, and best practices.

Technical Skills

• Proficiency in healthcare management systems, electronic medical records (EMR), and Microsoft Office applications.

Regulatory Knowledge

• Familiarity with HIPPA, NCQA, URAC, and other healthcare compliance standards.