A Quality Review Specialist is responsible for coordinating the quality review activities and resources that support ad-hoc medical file review operations. Essential functions listed on the Quality Review Specialist Resume as – developing and executing strategies that certify the output of high-quality medical file review reports; performing quality review audits, drawing on clinical experience and knowledge, recording and tracking quality data and billing information, performing timely follow-up on customer communications, coordinating with referral team and nurse manager as needed, participating in ongoing quality program refinements, participating in the onboarding of new consultants, and completing other duties as assigned.
To excel in the role, the following skills are needed – strong bias for action with a sense of urgency and high energy; customer focus skills, the ability to speak and communicate well, teamwork skills, technical skills, and basic understanding of insurance risk concepts. A relevant degree and currently registered nurse licensure are vital for this role.
Headline : Looking to obtain a Quality Review Specialist position that utilizes my training and experience in the customer service, delivery, communications, and quality control field.
Acquired and verified hazard insurance and property taxes.
Verified current and past employment.
Calculated income using paystubs, W2, income taxes, and bank statements.
Obtained and reviewed title policies.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Science In Paralegal
Quality Review Specialist Resume
Objective : To obtain a rewarding and challenging Quality Review Specialist position with a progressive organization where my experience and abilities will enable me to make a strong immediate contribution and allow me the opportunity for growth and advancement.
Performed qualitative, concurrent review of clinical documentation upon admission, recertification, resumption of care, and discharge documentation and associated physician orders, and additional routine audits.
Reviewed all clinical documentation, with a focus on data accuracy and consistency.
Upon discussion/collaboration with clinicians, amends documents as needed to assure consistency and accuracy of information.
Assessed the overall Plan of Care to determine consistency with clinical documentation.
Ensuring consistency of HHRG assignment with the documented Plan of Care.
Applied coding principles accurately, and in accordance with documented patient acuity levels Reviewed medication profiles and physician orders (signing as indicated) assuring accuracy and completeness.
Collected and summarized data related to documentation inconsistencies.
Experience
2-5 Years
Level
Executive
Education
Associate In RN
Quality Review Specialist Resume
Objective : A career with an organization where interpersonal, technical, and leadership skills are essential, and where I can improve quality of care given to patients who receive services through the organization.
Skills : Bilingual, Ability to Multitask, Microsoft Office, Critical Thinking, Strong Communication , Positive Attitude Flexible, Relationship Building.
Description :
Collaborated with the Presence Medical Group Chief Medical Officer to create quality metrics to be reported to the Presence Health system and brainstorm on ways to pull data from EpicCare EMR system.
Collected, analyzed, and reported provider compensation metrics to primary care physicians on a monthly basis for quality measures.
Gathered identified quality metrics for PMG physicians from medical records and management reports, interpret, and analyze the data by creating detailed reports for the Director of Quality Improvement to present to the Quality Committee.
Communicated with PMG physicians, office leaders, Regional Directors, VP's of Operations, and office staff regarding reports related to medical record review and CMS Meaningful Use measures and provide suggestions on how to improve percentages to reach goals of the medical group and CMS requirements.
Created and provided ambulatory medical record review and patient quality and safety reports to over 100 PMG providers on a monthly and quarterly basis to meet PMG goals.
Served as a resource for physicians, mid-level practitioners, office leaders and practice directors by providing guidance on information regarding quality improvement processes and projects.
Conducted yearly office visits to all of the PMG physician offices to observe that appropriate quality procedure are followed.
Experience
2-5 Years
Level
Junior
Education
Master Of Health Administration
Quality Review Specialist Resume
Headline : Experienced with proprietary software for data entry, retrieval and analysis; updating and maintaining customer data; ensuring compliance with federal regulations and company ethics. Familiar with all office equipment Proficient with all Microsoft office applications Ensure Customer confidentiality Handle customers professionally and genuinely Consistently meet quality and production standards.
Skills : MS Office, Planning Skills, Documentation.
Description :
Responsible for identifying CORE patients (patients with pneumonia, acute myocardial infarction, or congestive heart failure).
Assured timely care and treatment of this patient population.
Daily tracked of CORE cases.
Communicated with physicians and nurses regarding CORE measures.
Collected concurrent CORE data and take corrective actions to ensure CORE success.
Educated nurses and physicians on CORE measures and any new CORE measure guidelines.
Reviewed and maintained results, documented trends, and interpret performance data to recommend, develop, and deliver education and training programs.
Experience
5-7 Years
Level
Executive
Education
Master In Science
Quality Review Specialist Resume
Objective : A Quality Review Specialist position that will provide opportunities to contribute to the goals and profitability of the organization while utilizing and developing my current skills.
Skills : Microsoft Office, Multitasking, Quality Manager.
Description :
Reviewed all loans in accordance with audit and compliance regulations, while focusing on underwriting worksheet analysis, HOI, title commitments, payoffs, financials, subordinations, legal reviews, rate lock requests, closing documents and procedures, processing documents, workflows and procedures, commitment letters, appraisals, the mortgage pricing tool, credit reports and verifying auto-debit forms by checking the account number via FSD; within the entire private bank mortgage site to promote quality assurance and decrease defects.
Performed daily audits and create reports to provide weekly quality assurance reviews to identify strengths and deficiencies to identify trends in which adversely affect quality assurance and otherwise put the bank at risk, while implementing new policies and procedures.
Cross-trained on functions throughout the entire department which includes, but is not limited to, closing, processing, preliminary documents, rate lock requests and changes, HMDA reporting, and underwriting tier 1 and tier 2 reviews.
Trained new employees on quality control processes, while researching and analyzing compliance inquiries and providing general guidance on a broad array of policies and regulations within quality control and auditing.
Quality assurance and process improvement-oriented with a strong focus on adhering to internal compliance, regulations, and procedures, while providing analyses to upper management to implement procedural revisions, with a major focus on meeting SLA and compliance regulations.
Demonstrated interpersonal effectiveness by establishing rapport and maintaining productive and professional relationships among the entire mortgage banking site, while working closely with management, processing, underwriting, closing, compliance, auditing, and legal departments.
Excellent producer by consistently maintaining the standard of 2% or less of the quality control productivity expectations and exceeding expectations.
Experience
2-5 Years
Level
Junior
Education
High School Diploma
Quality Review Specialist Resume
Objective : Very detail-oriented with the ability to work in a multitask environment as well as to adapt to changing priorities. A problem-solver who uses analytical skills, exceptional professional qualities, and knowledge of company business to solve customers' concerns.
Assisted in establishing standards, monitoring job performance for accuracy, timeliness, procedural protocol, and compliance with regulatory requirements specific to the department, with the purpose of identifying performance issues and potential training needs.
Analyzed departmental data to create reports on both individual and group performance according to established standards and documented business processes.
Provided employees with knowledge and skills for their current and future job performance through job-specific, technical, and soft skills training.
Partnered with employees to identify areas of improvement and well as implement development plans with the manager for coaching opportunities.
Played a key role in the implementation of the Witness system, assisting with the configuration documentation, creating evaluation forms, test scripts, assigning business rules, properties, and performing end user testing facilitation.
Granted administrative access to the Witness system to assist with any issues, changes, or requests.
Assisted with special projects and assignments as designated.
Experience
2-5 Years
Level
Executive
Education
Associate In Science In Management
Quality Review Specialist Resume
Objective : As a Quality Review Specialist, responsible for Assisting with the development/writing of SOPs and other quality documents and/or reports as needed, and also Providing consultation on quality and compliance topics in areas of expertise.
Skills : Management, Analytical, Efficiency, Microsoft Word, Adobe, Encompass, Process Improvement, Training & Development, Time Management, Organizational Skills.
Description :
Involved in assisting in clinical quality reviews via medical record review, data abstraction, and submission.
Focused on driving improvement via education of hospital staff.
Specialized experience in regards to making recommendations to assist in the improvement of facilities and safe working conditions for occupational hospital staff.
Determined safety needs and implementation of the interventions for the safety and quality requirements, I provide guidance, direction, and advice for safety, quality, patient care, and individualized safety concerns to Managers, Supervisors, and Directors of Medical staff and nursing staff.
Executed internal control by auditing Conventional, VA, and FHA loans for compliance with bank guidelines and federal regulations.
Managed daily pipeline, communicated errors, verified tax and payoff amounts for accuracy.
Adapted to rapid changes and tense deadlines.
Experience
0-2 Years
Level
Entry Level
Education
Bachelors
Quality Review Specialist Resume
Objective : As a Quality Review Specialist, responsible for Providing training in quality and compliance topics in areas of expertise, Serving as client quality liaison and/or a quality host of client audits; coordinates responses to client audits.
Skills : Erequest, OnBase, Meditech, HOST, Microsoft Word.
Description :
Completed data entry for all new loan packages for the Correspondent Channel to ensure compliance with CitiMortgage's guidelines.
Analyzed accuracy and completeness of loan documents and information based on internal procedures and policies.
Ensured the integrity of the data within the closed loan package and CitiMortgage's systems.
Responsible for routing loans to the appropriate department.
Focused on developing a proficient level of expertise on all basic tasks related to the data entry and loan purchasing processes.
Consistently met quality and production standards.
Provided a quality review of appraisals on a wide variety of residential properties that serve as collateral for loans secured by real estate.
Experience
2-5 Years
Level
Executive
Education
MS
Quality Review Specialist Resume
Summary : Well-rounded and energetic professional with 10 years of diverse experience across operations management, team leadership, quality assurance, risk management, and clients relations. Offer track record of improving efficiency and productivity by evaluating, streamlining, and optimizing processes and practices. Confidently lead and motivate top-performing teams. Command superior analytical, technical, and organizational skills. Dedicated to enhancing business operations and maximizing the bottom line.
Skills : Business Administration, Loan Servicing, Negotiations, Strategic Planning, Customer Service, Recruitment Strategies, Collections, Policy/Procedure Development, Call Center, Leadership And Training, Personnel Management.
Description :
Promoted from Phone Service Representative.
Directly monitored inbound customer service telephone calls to ensure compliance with policies and procedures.
Implemented and streamlined processes, procedures, and quality requirements to maximize efficiency.
Reviewed and graded each representative, against a predetermined scale, for quality and accuracy.
Monitored staff performance to achieve strategic and tactical goals.
Analyzed policies, procedures, and processes to ensure regulatory compliance and sound business practices.
Performed quality review and approval of documents, all types of data, protocols, and/or reports.
Experience
10+ Years
Level
Senior
Education
High School Diploma
Quality Review Specialist Resume
Objective : Seeking a permanent Quality Review Specialist position in the mortgage industry that utilizes my analytical skills and enables me to make a positive contribution to the organization.
Skills : RHIA, HIM, Medical Records, Abstractor, Customer Service.
Description :
Transferred calls that have been loaded to the SFTP site Keep a report of how many enrollments were completed by the FMO/EDC, track how many calls were requested, and how many evaluations were completed each week Host weekly or bi-weekly calibration sessions to ensure we are calibrated or to discuss trends /process.
Discussed the quality expectations and how to achieve those goals.
Ensured appraisal report is complete and conforms to USPAP and lender underwriting guidelines.
Worked with other departments to update underwriting guidelines when needed and to ensure they are accurate and easily understood.
Frequently worked overtime in order to assist with achieving department goals.
Monitored Accreditation Association for Ambulatory Health Care (AAAHC) standards related to clinical and office workflow processes for all Presence Medical Group provider offices.
Produced reports and provides feedback to clinicians and management staff.
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