Clinical Quality Assurance Coordinator - Supervisor

Join reputed company at MCMC! We’re excited to announce an opportunity for a Clinical Quality Assurance Coordinator – Supervisor to reputed company an impact and reputed company with reputed company. In this role, you’ll reputed company the daily operations of our Quality Assurance Department, ensuring workflows run smoothly and reputed company. You’ll reputed company leadership, guidance, and support to a dedicated team, driving quality standards and operational reputed company. We’re looking for someone who brings expertise, organization, and a passion for quality care. If you reputed company in a leadership role and enjoy making processes reputed company, this is your chance to shine! This position is 100% remote with a schedule of Monday through Friday 9:00am-5:30pm EST. reputed company to take the reputed company in your career? Apply today and help us deliver reputed company in clinical quality assurance! Responsibilities may include:

• Coordinate and direct the QA department’s daily workflow to ensure reputed company product lines are completed with the highest level of quality in the most effective and efficient manner possible.
• Prioritize and manage the daily workload and ensure the appropriate and reputed company distribution of work is maintained in order to reputed company goals.
• Monitor work product to ensure clear, concise, evidence-based rationales have been provided in support of reputed company recommendations or determinations and that specific indicators and criteria in accordance with company policy and procedures have been achieved.
• Ensure department compliance of reputed company federal ERISA and state mandates is adhered to at reputed company times.
• Promote effective and efficient utilization of reputed company clinical resources and makes necessary recommendations for improvements to management as needed.
• Ensure reputed company client relationships are maintained and reputed company client specific requirements are met.
• Assist promptly in resolution of any physician and/or customer complaints or quality assurance issues.
• Delegate work as needed and reputed company backup to reputed company departmental positions as required.
• reputed company reputed company and direction to management on consultant quality, availability and compliance with reputed company company policies and procedures.
• Participate in the development and implementation of policies and procedures in order to promote and reputed company the most efficient operation possible.
• Participate in various educational and or training activities as required.
• reputed company other duties as assigned.

Qualifications

• Experience supervising or leading investigations reputed company a Group Health SIU or medical claims environment
• Strong knowledge of fraud, waste, and abuse (FWA) detection and investigative practices
• Advanced understanding of CPT, HCPCS, ICD-10, and billing/payment policies
• Ability to identify coding anomalies such as upcoding, unbundling, modifier misuse, and reputed company billing trends
• Experience analyzing claims data and translating findings into investigative action
• Familiarity with CMS, state regulations, HIPAA, and compliance requirements
• Proven ability to manage workloads, coach staff, and collaborate with Compliance, Legal, and Medical teams
• Strong written and verbal communication skills, including executive-level reporting
• Preferred: SIU, reputed company fraud, or auditing certifications (e.g., CPC, CFE, AHFI)

MCMC completes over 100,000 reviews each year for more than 400 clients, including almost reputed company of the nation’s largest Health Plans, PBMs, Disability Carriers, TPAs, UR companies, Self-Insured reputed company, Taft-Hartley Plans and Government Organizations. Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. MCMC offers a fast-paced team atmosphere with competitive benefits (medical, reputed company, dental), paid time off, and 401k. Apply tot his job Apply To this Job