Clinical Quality Assurance Specialist
Wellpoint Health Ltd.
13d ago

About Wellpoint : Wellpoint Health has been recognized by Profit 500 as one of the fastest growing businesses in Canada. We provide a full range of workplace services including Medical Assessments, Disability Case Management, Wellness, Prevention and Compliance programs.

Our services help our customers improve employee health, attendance, and productivity, strengthening their business and improving their bottom line.

Exciting things we offer to our Team * Competitive Benefit Plan including Health and Dental, because we care about our employees * A Personal Spending Account * Corporate gym memberships * Educational Reimbursement, because we believe in personal and professional development* Training & Development, we focus on individual development plan* Team and Corporate events Position Summary : Reporting in to the Manager of Clinical Services, Clinical QA personnel are responsible to perform the second stage in the report QA process.

Responsibilities : * Review and apply quality assurance (QA) process to produce defensible, evidence based, objective and impartial medical reports* Prioritize QA by report due date* Review file documentation and first stage QA comments / suggestions to ensure inclusion of applicable information within report* Correspond with referral source as required to clarify issues such as provided questions, issue in dispute, etc.

  • Provide second review from clinical perspective regarding consistency between information in report and the documentation on file* Provide second review from clinical perspective with respect to anatomical terms, grammar, spelling, punctuation, etc.
  • Provide clinical review with regards to consistency between assessors’ reports* Provide second / clinical review to ensure questions posed are correct and adequately addressed* Provide second review with respect to ensuring that documentation list / template is accurate* Ensure any special instructions requested by the referral source have been implemented* Address flagged changes / discrepancies / queries / revisions from first stage QA* Ensure that reports are properly placed into approved templates* Communicate with referral source as required regarding late reports, documentation required, etc.
  • Engage in necessary clarification / literature review to ensure that information within report and assessors’ opinions are supported * Facilitate completion of finalized report by sending report to assessor with proposed QA, answering questions posed by assessor, and implementing any requested revisions* Follow-
  • up with assessors regarding reports sent for QA if not received within less than 24 hours* Fully and consistently document communications with assessors and referral sources, including feedback and directives regarding QA process and approval to release report* Liaise with intake coordinators as required to confirm status of reports and to address questions / issues posed by assessor, QA team, referral source, etc.

  • Answer phone calls / enquiries regarding reports as required * Perform other related duties as required Skills & Experience : * Must have a minimum of 5 years clinical experience as a Regulated Health Practitioner* Independent Medical Assessment experience, an asset* Microsoft Office Suite and basic office equipment* Effective verbal, written and listening communication skills* Strong organizational and interpersonal skills with ability to work independently and with others* Decision making / judgment skills* Problem solving skills * Attention to detail and high level of accuracy* Time management skills* Comfortable typing 40-
  • 50 words per minute* Ability to engage in discussion and conflict management as required Wellpoint is committed to accessibility for persons with disabilities.

    Upon individual request, Wellpoint will endeavour to remove barriers to the hiring process to accommodate those candidates with disabilities.

    Should any applicant require accommodation through the application, interview or selection processes, please contact Human Resources for assistance.

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