IME RESOURCES LLC

Role Description The Conditional Payment Specialist is responsible for working with Medicare and its contractors to obtain documentation, ensure timely follow-ups are made, and timely and accurate updates are provided to clients. This position ensures all services are completed with the highest quality and integrity and all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates. This is a remote full-time position with a standard work schedule Monday-Friday, 8am-5pm EST. It may be necessary to work overtime depending on business needs. Essential Job Functions - Investigate new referrals, clarify information received with the Conditional Payment Referral Coordinator and the nature of the assignment with the client or Account Executive. - Follow up with the applicable Medicare contractor to track status of each claim. - Respond to internal and external emails and phone calls in a timely manner. - Triage conditional payment correspondence upon receipt. - Appropriate documentation of all system notes and e-mails. - Work with Team Manager to ensure client correspondence is logical and up to date. - Assist with addressing issues and solving problems as needed. - Assist other team members as needed and directed by management. - Regularly communicate with management and provide support as needed. - Abide by all rules of the company such as safety, confidentiality and organizational directives. - Perform Medicare Eligibility Inquiries and Verifications as needed. - Perform Medicare Advantage Plan and Medicaid services as needed. - Perform Treasury-related services as needed. - Perform other duties as assigned by management. Qualifications - Must be knowledgeable with business terminology, administration and management. - Must be able to adequately operate a computer, fax machine, copier, scanner, and telephone. - Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. - Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals. Ability to compute rates and percentages. - Ability to demonstrate strong customer service skills. - Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. - Ability to follow instructions and respond to management’s directions accurately. - Must possess excellent skills in English usage, grammar, punctuation and style. - Must be able to work independently, prioritize work activities and use time efficiently. - Ability to concentrate and multitask in a fast-paced work environment. - Must be able to maintain confidentiality. - Must be able to demonstrate and promote a positive team-oriented environment. - Must be able to work well under pressure and/or stressful conditions. - Must possess the ability to manage change, delays, or unexpected events appropriately. - Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. Benefits - Competitive benefits (medical, vision, dental) - Paid time off - 401k

Role Description We're looking for a Remote Client Coordinator to join our team! - Full-time position: Monday-Friday, 12:00pm-8:30pm EST - Competitive pay: $17 to $19 per hour - Location: Fully Remote! The Client Coordinator is responsible for servicing inquiries from clients, physicians, nurses, or any representative acting on behalf of a client. This position is responsible for data preparation, data entry, data tracking, documentation, and filing. All duties are handled with a high degree of quality customer service and in compliance with all regulatory and company standards. Duties & Responsibilities - Handle and respond promptly to inquiries from clients and/or anyone acting on behalf of the client regarding questions, report status, concerns, or general requests for information. - Utilize appropriate systems and databases to enter client or claimant information and/or retrieve information. - Maintain daily contact with the QA department regarding workflow and pending report status. - Contact providers for assignment and update database. - File and archive open and closed cases. - Verify all client information is current in the database and all client specific guidelines and/or rules or information is documented in the system. - Work independently and in partnership with other team members to ensure that questions are addressed, documented, and cases are returned in a timely fashion. - Direct calls to other departments as needed. - Perform various clerical duties such as typing, filing, emailing, and proofreading. - Assist in resolution of customer complaints and quality assurance issues. - Notify management of any report issues or concerns. - Ensure all practices are carried out in accordance with state and federal safety and legal regulations. - Perform other duties as assigned. Qualifications - High school diploma or equivalent required. - Minimum one year clerical experience; or equivalent combination of education and experience preferred. - Experience in a medical office or insurance industry preferred. - Must possess complete knowledge of general computer, fax, copier, scanner, and telephone. - Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. - Must have ability to be trained on and adhere to HIPAA regulations and compliance standards. - Must be a qualified typist with a minimum of 40 W.P.M. - Ability to follow instructions and respond to management’s directions accurately. - Must demonstrate accuracy, thoroughness, and responsibility for quality of work, and ability to take initiative to identify improvements. - Must demonstrate exceptional communication skills. - Must be able to work independently, prioritize work activities, and use time efficiently. - Must be able to maintain confidentiality. - Must be able to demonstrate and promote a positive team-oriented environment. - Must be able to stay focused and concentrate under normal or heavy distractions. - Must be able to work well under pressure and/or stressful conditions. - Must possess the ability to manage change, delays, or unexpected events appropriately. - Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. Benefits - Fast-paced team atmosphere - Competitive benefits - Paid time off - 401k Company Description MES Solutions, a respected pioneer of the independent medical examination (IME) and peer review services industry, is setting the standard for independent review services nationwide. We handle evaluations for a variety of property and casualty insurers, self-insureds, and third-party administrator’s business lines such as: automotive, disability, liability, group health, long-term care, FMLA, and workers' compensation. IME and Peer Review services play an important role in evaluating the appropriateness, medical necessity, cost, as well as certification of requests for care. IME services and Peer Review services are provided by MES Solutions, accredited by URAC for CORE Organizational Quality, and MES Peer Review Services, a URAC accredited Comprehensive Independent Review Organization, respectively. MES is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Role Description The Clinical Quality Assurance Coordinator Supervisor is responsible to oversee the daily workflow of the Quality Assurance Department and provide leadership and direction to ensure operations run as efficiently and effectively as possible. This position is required to have a complete understanding of the duties required below and provide overall direction and support to the Quality Assurance Department. This position is 100% remote with a schedule of Monday through Friday. You can start your day anytime between 7:00am-9:00am EST and end between 3:30pm-5:30pm EST. Essential Job Functions: - Coordinate and direct the QA department’s daily workflow to ensure all 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 equitable distribution of work is maintained in order to achieve goals. - Monitor work product to ensure clear, concise, evidence-based rationales have been provided in support of all recommendations or determinations and that specific indicators and criteria in accordance with company policy and procedures have been achieved. - Ensure department compliance of all federal ERISA and state mandates is adhered to at all times. - Promote effective and efficient utilization of all clinical resources and makes necessary recommendations for improvements to management as needed. - Ensure all client relationships are maintained and all 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 provide backup to all departmental positions as required. - Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures. - Participate in the development and implementation of policies and procedures in order to promote and achieve the most efficient operation possible. - Participate in various educational and or training activities as required. - Perform other duties as assigned. Essential Supervisory Responsibilities: - Carrying out all responsibilities in accordance with the company’s standards, policies, and all applicable employment laws. - Managing and monitoring workflow and providing support, training, and techniques to assist staff in achieving department daily/weekly/monthly goals and standards. - Encouraging positive morale, maintaining harmony among staff, and resolving grievances when necessary. - Overseeing the completion and approval of employee timecards and coordinating overtime needs with management and staff as needed. - Actively participating in the department’s staffing requirements including hiring, onboarding, and separating of employees. - In conjunction with management, creating and implementing plan to meet department’s goals and metrics based on workload and client needs. - Communicating change effectively and supporting those affected by change. - Supervising insubordinate staff when warranted and initiating coaching or corrective actions as required and/or directed by upper management. - Evaluating staff needs and performance, providing periodic feedback to staff and reporting any performance concerns and/or recommendations growth opportunities to management. - Actively participating and successfully conducting annual performance evaluations. Qualifications - High school diploma or equivalent required. - A minimum of two years clinical or related field experience; or equivalent combination of education and experience. - Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability. - Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. - Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. - Must be a qualified typist with a minimum of 40 W.P.M. - Must be able to operate a general computer, fax, copier, scanner, and telephone. - Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. - Must possess excellent skills in English usage, grammar, punctuation and style. - Ability to follow instructions and respond to upper management’s directions accurately. - Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. - Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. - Must be able to work independently, prioritize work activities and use time efficiently. - Must be able to maintain confidentiality. Benefits - Competitive benefits (medical, vision, dental). - Paid time off. - 401k. Company Description MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.

Role Description Are you a Medical Assistant looking to break free from the traditional office setting? If you're craving a fresh career path, this opportunity is tailor-made for you! ExamWorks is hiring a Quality Assurance Coordinator to join our remote team. In this role, you’ll be the final checkpoint for medical reports - ensuring accuracy in grammar, medical terminology, and content. Your keen eye for detail will help uphold the highest standards of quality and care. This position is 100% remote with your choice of: - 3 - 12 hour shifts, Friday-Sunday 7:00am-7:30pm CST - 4 - 10 hour shifts, Wednesday-Saturday 9:30am-7:00pm CST Responsibilities may include: - Perform quality assurance review of reports, correspondences, addendums or supplemental reviews. - Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. - Ensure that all client instructions and specifications have been followed and that all questions have been addressed. - Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. - Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. - Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report. - Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. - Ensure the provider credentials and signature are adhered to the final report. - Identify any inconsistencies within the report and contact the Provider to obtain clarification, modification or correction as needed. - Assist in resolution of customer complaints and quality assurance issues as needed. - Ensure all federal ERISA and/or state mandates are adhered to at all times. - Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. - Promote effective and efficient utilization of company resources. - Participate in various educational and or training activities as required. - Perform other duties as assigned. If you're ready to bring your clinical expertise into a remote setting and make a meaningful impact behind the scenes, we want to hear from you! Qualifications - Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. - Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. - Must be a qualified typist with a minimum of 40 W.P.M preferred. - Must be able to operate a general computer, fax, copier, scanner, and telephone. - Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. - Must possess excellent skills in English usage, grammar, punctuation and style. - Ability to follow instructions and respond to upper management’s directions accurately. - Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitor own work to ensure quality is met. - Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. - Must be able to work independently, prioritize work activities and use time efficiently. - Must be able to maintain confidentiality. - Must be able to demonstrate and promote a positive team-oriented environment. Benefits - Competitive benefits (medical, vision, dental) - Paid time off - 401k

Job DetailsJob Location: Norwood, MA 02062Position Type: Full TimeSalary Range: $30.00 - $31.25 HourlyCraving a New Adventure? Flex Your Clinical Skills Right from Your Couch! Are you a Registered Nurse (RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? MES has the perfect opportunity for you! We’re looking for a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll be responsible for ensuring that Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates. Why This Role Rocks: 100% Remote – Enjoy the flexibility of working from home! Impactful Work – You’ll play a key role in ensuring the quality and compliance of critical reports. Pick a Schedule That Works for You – Monday through Friday with rotating weekend shifts. You can start your day anytime between 7:00am-9:00am and end between 3:30pm-5:30pm EST with 1 late night per week from 12:00pm-8:30pm EST. Responsibilities include: Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensure that all client instructions and specifications have been followed and that all questions have been addressed. Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report. Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assist in resolution of client complaints and quality assurance issues as needed. Ensure all federal ERISA and state mandates are adhered to at all times. Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned. If you’re a motivated, energetic RN ready to take on an exciting new challenge, we want you on our team! At MES, we offer a dynamic environment where your skills will shine. QualificationsHigh school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability. Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance. MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Job DetailsJob Location: Norwood, MA 02062Position Type: Full TimeSalary Range: $27.00 - $29.00 HourlyTravel Percentage: NoneCalling All LPNs/LVNs! Are you an LPN/LVN looking for an exciting new opportunity? MES is on the hunt for a talented Clinical Quality Assurance Coordinator to join our growing team! In this role, you’ll dive into medical records, pulling out key details and crafting detailed narrative summaries. Your keen eye for detail will make you an invaluable part of our quality assurance process. Why You’ll Love This Role: -100% Remote – Work from where you're most comfortable - home! -Flexible Hours – Monday-Friday. Start your day between 7:00am and 12:00pm EST, and end between 3:30pm and 8:30pm EST. -Great Training – The first 4-6 weeks of training are designed to set you up for success, with a preferred training schedule of 12:00pm-8:30pm EST. At MES, we’re an employee-first company offering fantastic benefits and incredible growth opportunities. If you’re ready to take the next step in your career with a team that values your expertise, we want to hear from you! Don’t wait—apply today and join us on this exciting journey! QualificationsMINIMUM REQUIRED QUALIFICATIONS Education and/or Experience High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred. Knowledge of the insurance industry, preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, or disability preferred. Certificates, Licenses, Registrations LPN/LVN/RN may be required based on business needs. ESSENTIAL COMPETENCIES QUALIFICATIONS Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be a qualified typist with a minimum of 40 W.P.M Must have a full understanding of HIPAA regulations and compliance. Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must demonstrate exceptional communication skills. Ability to follow instructions and respond to upper managements’ directions accurately. Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. Must be able to demonstrate and promote a positive team -oriented environment. Must be able to stay focused and concentrate under normal or heavy distractions. Must be able to work well under pressure and or stressful conditions. Must possess the ability to manage change, delays, or unexpected events appropriately. Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. LANGUAGE/COMMUNICATION SKILLS Ability to read, analyze and interpret common correspondence, medical records, and legal contracts and documents. Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar. Ability to respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community. Ability to effectively present information one-on-one or in small groups. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position generally consists of: Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs. Ability to operate a computer up to 4 hours at a time. Ability to travel to different floors of the office or other locations. Ability to move throughout the office. Occasionally lifting and/or carrying up to 10 lbs. Occasionally pushing/pulling up to 10 lbs. Occasionally subject to bending, squatting or twisting. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Extended hours are occasionally required beyond the regular eight (8) hour work day. The noise level in the work environment is usually moderate.

Job DetailsJob Location: Lawrenceville, GA 30043Position Type: Full TimeSUMMARY The Quality Review Manager is responsible to work autonomously to complete full audit, review and approval of the following, but not limited to: Life Care Plans, Medical Cost Projections, Medicare Set-Aside Allocations, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews, initial and progress reports for medical or vocational case management files and other reports as needed within the scope of nursing practice and certifications. The Quality Review is responsible to monitor the overall quality of all the work products and effectively communicate with the planner team to include development of alternative treatment plans or recommendations for moving the file toward maximum resolution at the highest level of quality and timeliness possible. ESSENTIAL JOB FUNCTIONS Collaborates with Planner team through education and recommendations on past/future treatment to optimize outcomes with client interfacing Work autonomously and collaborate with the Clinical Services Team and all company personnel as needed and communicate with the accounts and attorneys as needed. Maintain through audit a quality work product evidenced by acceptable quality scores and standards. Participate in company orientation, management meetings and/or conference calls as required. Ensure all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times. Provide insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned. ESSENTIAL MANAGERIAL RESPONSIBILITIES Carrying out all responsibilities in accordance with the company’s standards, policies, and all applicable employment laws. Managing and monitoring workflow and providing support, training, and techniques to assist staff in achieving department daily/weekly/monthly goals and standards. Encouraging positive morale, maintaining harmony among staff, and resolving grievances when necessary. Overseeing the completion and approval of employee timecards and coordinating overtime needs with management and staff as needed. Actively participating in the department’s staffing requirements including hiring, onboarding, and separating of employees. Creating and implementing plan to meet department’s goals and metrics based on workload and client needs. Communicating change effectively and supporting those affected by change. Managing insubordinate staff when warranted and initiating coaching or corrective actions as required and/or directed by upper management. Evaluating staff needs and performance, providing periodic feedback to staff and reporting any performance concerns and/or recommendations growth opportunities to management. Actively participating and successfully conducting annual performance evaluations. QualificationsMINIMUM REQUIRED QUALIFICATIONS Education and/or Experience Associates degree required. Bachelor’s degree in health-related field preferred. Three to five years Medicare Compliance preferred and a minimum of three years worker’s compensation experience. Certificates, Licenses, Registrations Active unrestricted Registered Nursing license. Must have minimum active certification in Medicare Set-Asides; additional certification in Life Care Planning and/or Legal Nurse Consulting preferred. ESSENTIAL COMPETENCIES QUALIFICATIONS Must have knowledge of the disability and workers' compensation industry including rules and regulations and an understanding of clinical procedures and all processes involved in the delivery of quality health care to an injured worker. Must be able to adequately operate a general computer and telephone. Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must have knowledge of current laws and regulations that govern delivery of rehabilitation services. Must have knowledge of human behavior and performance. Ability to demonstrate strong customer service knowledge including needs assessment, meeting quality standards for services and evaluation of customer satisfaction. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Ability to concentrate and multitask in a fast-paced work environment. Must demonstrate accuracy and thoroughness and look for ways to improve and promote quality and monitor own work to ensure quality is met. Must be able to maintain confidentiality. Must be able to demonstrate and promote a positive team -oriented environment. Must be able to work well under pressure and/or stressful conditions and have the ability to manage change, delays, or unexpected events appropriately. Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. LANGUAGE/COMMUNICATION SKILLS Ability to read, analyze and interpret common correspondence, medical records and itemized billing statements, and legal contracts and documents. Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar. Ability to respond appropriately and professionally to all inquiries or complaints from customers, regulatory agencies, upper management, and/or members of the business community. Ability to effectively present information one-on-one, in small groups, and/or to clients or vendors of the company. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position generally consists of: Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs. Ability to operate a computer up to 8 hours at a time. Ability to travel to different floors of the office or other locations, if position is transitioned from remote. Ability to move throughout the office, if position is transitioned from remote. Occasionally lifting and/or carrying up to 10 lbs. Occasionally pushing/pulling up to 10 lbs. Occasionally subject to bending, squatting or twisting. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Extended hours are occasionally required beyond the regular eight (8) hour work day. Works in a home office environment and/or occasionally from an office environment. The noise level in the work environment is usually moderate.

Job DetailsJob Location: Rockford, IL 61108Position Type: Full TimeSalary Range: $45.00 - $52.00 HourlyAre you passionate about clinical quality, accuracy, and continuous improvement -and looking for a role that allows you to make a meaningful impact while working from home? We’re seeking a Utilization Review & Quality Assurance Specialist to join our fully remote team. This role offers a consistent 8:00am-4:30pm EST schedule, providing structure and work-life balance while you contribute to high‑quality clinical review operations. In this role, you’ll be at the center of ensuring excellence - leveraging strong knowledge of group health plans, clinical criteria sets, leadership, and change management to review clinical documentation, uphold regulatory and client standards, and drive quality across medical review processes. Responsibilities may include: Evaluate clinical information received, write and/or review various reports including, but not limited to: Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements. Perform quality assurance reviews of peer review reports, correspondences, addendums or supplemental reviews to ensure they meet company standards for content, clarity, evidence-based rationale, formatting, and professional presentation. Ensure all client instructions and specifications have been followed, all questions have been answered, and all recommendations or determinations are supported by clear, concise, and evidence-based rationales. Verify that each review includes appropriate clinical citations when applicable, and ensure all references cited are current and obtained from reputable medical journals and publications. Identify inconsistencies within reports and contact the reviewer to obtain clarifications, modifications, or corrections needed. Assist in the resolution of customer complaints and quality assurance issues as appropriate. Ensure all federal ERISA and applicable state mandates are adhered to. Provide ongoing feedback and recommendations to management regarding consultant performance, quality trends, and compliance with internal and client specific requirements. Participate in the development and implementation of policies and procedures to improve efficiency and quality across operations. Develop and lead formal and informal training sessions -individually or in groups -that promote high-quality utilization review practices and reinforce company standards. Develop and document new or improved operational processes to support continuous improvement. Promote effective and efficient utilization of company resources across all responsibilities. Participate in or lead various continuing education and training activities related to clinical knowledge, industry standards, and company processes. Perform other duties as assigned. Qualifications Must hold and maintain a Registered Nursing License. Strong knowledge of group health/criteria sets/leadership/change management. Must have strong understanding of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values. Must be proficient in Microsoft Office Suite, Outlook, internet navigation and general office equipment. Must have the ability to follow instructions and respond to upper managements’ directions accurately. Ability to work independently, prioritize tasks, and manage time efficiently in a fast-paced environment. Ability to demonstrate accuracy, thoroughness, and commitment to producing high quality work; actively monitor own performance and seek opportunities for improvement. Ability to demonstrate flexibility and remain composed under pressure or in stressful conditions; adapts well to change and promotes a positive team environment. Must be able to maintain confidentiality. Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Equal Opportunity Employer - Minorities/Females/Disabled/Veterans ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Job DetailsJob Location: Tampa, FL 33619Position Type: Full TimeSalary Range: $22.00 - $26.00 HourlyTravel Percentage: NoneAre You a Florida‑Based Paralegal in the Claims World? Applicants must currently reside in Florida or have litigation experience in Florida to be considered. If you're already a Paralegal in the claim's world looking to supercharge your career in a fast-paced, dynamic environment, then we've got an exciting opportunity for you! ExamWorks is looking for a Client Coordinator to join our team! The Client Coordinator is responsible for servicing inquiries from clients, physicians, nurses or any representative acting on behalf of a client. This position is responsible for data preparation, data entry, data tracking, documentation and filing. All duties are handled with a high degree of quality customer service and in compliance with all regulatory and company standards. The role is 100% remote, Monday to Friday 8:30am-5:00pm EST. ESSENTIAL JOB FUNCTIONS Handle and respond promptly to inquiries from clients and/or anyone acting on behalf of the client regarding questions, report status, concerns, or general requests for information. Utilize appropriate systems and databases to enter client or claimant information and or retrieve information. Maintain daily contact with the QA department regarding workflow and pending report status. Contact providers for assignment and update database. File and archive open and closed cases. Verify all client information is current in the database and all client specific guidelines and or rules or information is documented in the system. Work independently and in partnership with other team members to ensure that questions are addressed, documented and cases are returned in a timely fashion. Direct calls to other departments as needed. Perform various clerical duties such as typing, filing, emailing, and proofreading. Assist in resolution of customer complaints and quality assurance issue. Notify management of any report issues or concerns. Ensure all practices are carried out in accordance with state and federal safety and legal regulations. Perform other duties as assigned. QualificationsEducation and/or Experience High school diploma or equivalent required. Minimum one year clerical experience; or equivalent combination of education and experience preferred. Experience in a medical office or insurance industry preferred. Paralegal experience preferred. QUALIFICATIONS Must possess complete knowledge of general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must have ability to be trained on and adhere to HIPAA regulations and compliance standards. Must be a qualified typist with a minimum of 40 W.P.M. Ability to follow instructions and respond to managements’ directions accurately. Must demonstrate accuracy, thoroughness, and responsibility for quality of work, and ability to take initiative to identify improvements. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. Must be able to stay focused and concentrate under normal or heavy distractions. Must be able to work well under pressure and or stressful conditions. Must possess the ability to manage change, delays, or unexpected events appropriately. Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages. ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws. ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Job DetailsJob Location: Atlanta, GA 30305Position Type: Full TimeSalary Range: $24.00 - $29.00 HourlyReady for a Rewarding Career that Fits Your Lifestyle? Imagine a job where you can keep your clinical skills sharp, tackle exciting challenges, AND work from the comfort of your own home. Sounds like the perfect mix, right? MES is looking for a self-driven, high-performing Registered Nurse (RN) or Licensed Vocational Nurse (LVN) to join our dynamic team as a Clinical Quality Assurance Coordinator. In this role, you’ll ensure our Peer Review case reports are nothing short of exceptional—delivering top-notch quality and integrity, all while staying fully aligned with client agreements, regulatory standards, and state and federal mandates. The position is 100% remote with a schedule of Monday through Friday: three days: 12-8:30PM EST two days: 8-4:30PM EST Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensures that all client instructions and specifications have been followed and that all questions have been addressed. Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report. Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists. Ensures the provider credentials and signature are adhered to the final report. Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assists in resolution of customer complaints and quality assurance issues as needed. Ensures all federal ERISA and/or state mandates are adhered to at all times. Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned. If you’re ready to make a real impact in healthcare, all while enjoying the flexibility of working remotely, we want to hear from you! Qualifications Active RN/LVN nursing license required. Must be a graduate of an accredited nursing program or related medical experience; bachelor's degree preferred. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance. Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws. Equal Opportunity Employer - Minorities/Females/Disabled/Veterans MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.