A Quality Reviewer is responsible for inspecting, monitoring, and proposing measures to correct and improve a company’s final products and processes in order to meet established quality standards. A well-drafted Quality Reviewer Resume mentions the following duties – preparing and implementing quality assurance policies and procedures, performing routine inspections and quality tests, identifying and solving workflow and production issues, ensuring that standards and safety regulations are observed, addressing and discussing issues and proposed solutions, and making recommendations for improvement; and creating training materials and operating manuals.
To qualify for this role, the following skills are required – working knowledge of tools, methods, and concepts of quality assurance, solid knowledge of relevant regulatory standards, good communication skills, and excellent data collection and analysis skills. Formal education includes a degree in a relevant field.
Objective : A Quality Reviewer focused on the development; as well as sustaining of comprehensive, quality programs/service models; which support various populations. Recognised for having leadership skills, global and strategic vision, strong drive to achieve, strong analytical / problem solving skills and a strong and committed work ethic. A team player, with a passion for helping others.
Skills : Office, Microsoft Office Suite, Collections, Customer Service.
Description :
Completed Provider Certification Reviews (PCR) by: Completing pre review activities according to the current established guidelines in DDA for the Home and Community Based Waiver Program and the PCR unit.
Differentiated appropriate review activities when assigned the role of team member, or team leader.
Collected evidence from a variety of sources, which involved observation, conversation, and record review.
Demonstrated knowledge of the waiver service being reviewed, and the accompanying policies, procedures, and regulations affecting the service, through questions asked, and decisions made regarding the quality of the provider services being reviewed.
Made accurate designations for all indicators in the tools to demonstrate knowledge of the waiver service being reviewed, and the accompanying policies, procedures, and regulations affecting the service.
Provided technical assistance, to providers, as it applies to interpretation and clarification of the indicators identified in Provider Certification Review Tools.
Conducted an exit meeting with the provider, that outlines the successes and the concerns identified in the review in a clear and concise manner.
Experience
2-5 Years
Level
Junior
Education
MA In Criminal Justice
Quality Reviewer Resume
Summary : Detail oriented Quality Reviewer with 13+ years of expertise in claims resolutions, customer issues in regards to complex claim reimbursement. Supporting a variety of adjudication and reimbursement claim issues in a self-funded and managed care environment including quality control, adjustment and data entry.
Skills : Microsoft Office: Word, PowerPoint, and Excel, Planning, Sales.
Description :
Audited and reviewed the accuracy of case processing activity such as claim payment, premium, collection, system structure and data entry to ensure compliance and consistency with administrative procedures and guidelines.
Provided subject matter expertise and served as a key resource for team members.
Developed and recommended training programs to address error trends.
Have seasoned knowledge of auditing procedures ad systems expertise for claim payment.
Performed audits and provided feedback on a weekly and monthly basis according to the audit process.
Audited in excess of 150 processors per month.
Worked to meet team OT requirements.
Experience
10+ Years
Level
Senior
Education
B.S In Physics & Chemistry
Quality Reviewer Resume
Summary : Quality Reviewer with 8 years of experience in Compiling data from monitored calls and preparing daily and monthly performance reports for staff representative review and analysis, Offering and providing assistance for new representatives, Attending staff meetings and providing input into problem resolution.
Recommended changes to improvements in department processing and procedures.
Recommended training programs to address error trends.
Conducted the review according to the requirements of the review process and current DDA policies, which include, but are not limited to: adhering to the established time-frames for completing the review.
Assisted strategists and consultants in producing high quality and compelling marketing material through the review process.
Identified training gaps and trends at both the team and individual level.
Met with managers to present findings and proposed solutions.
Exhibited strong time management skills by balancing large question count caseloads and conflict resolution ability in strategist and consultant appeals of quality review edits.
Experience
7-10 Years
Level
Management
Education
B.S In Physics & Chemistry
Quality Reviewer Resume
Summary : Quality Reviewer professional with over 20 years of progressive experience with increased levels of responsibility in records management that requires the following skill sets: HIPPA Regulations Records Reconciliation Electronic Patient Data Validation Physician Data Management Attention to Detail Master Patient Index Audits.
Monitored multiple areas of feedback for each Customer Service Representatives on assigned teams.
Worked with Managers, Trainers, and Technical Coaches to identify gaps in training.
Managed team's workload and calendar through case assignment responsibilities.
Gathered and obtained quantitative and qualitative data to determine what degree services are delivered in compliance with the federal and state laws and agency policy.
Travelled throughout the state of South Carolina to conduct state quality reviews of DSS child protective cases through case review audits.
Experience
10+ Years
Level
Senior
Education
High School Diploma
Quality Reviewer Resume
Summary : Administrative Quality Reviewer professional with over 20 years of progressive experience with increased levels of responsibility in records management that requires the following skill sets: HIPPA Regulations Records Reconciliation Electronic Patient Data Validation Physician Data Management Attention to Detail Master Patient Index Audits.
Skills : Data Management, Record Management, Planning.
Description :
Identified record deficiencies and missing patient health information.
Verified all documentation for legibility and accuracy.
Assigned deficiencies to appropriate physician for completion in a timely manner.
Protected PHI based on HIPPA Guidelines.
Processed and verified record completion and accuracy for ROI request.
Verified electronic patient data for correct patient and PHI.
Assisted with MPI master patient index audits and clean up.
Experience
7-10 Years
Level
Management
Education
High School Diploma
Quality Reviewer Resume
Objective : Goal oriented Data Entry Clerk dedicated to high levels of custom satisfaction and meeting aggressive business goals. Data Entry Tech who successfully manages multiple data entry projects at once. Transcription expert focused on delivering high quality results in a timely manner. Skilled in planning and organising with the ability to complete tasks on deadline Data Entry specialist adept at developing and maintaining database.
Skills : Data Entry, Billing/Invoicing, Customer Service.
Description :
Performed individual and high quality work reviews on multiple tax programs.
Identified error trends, missing or incorrect entries.
Reviewed employee data entry for accuracy.
Kept daily spread sheets on employee's errors.
Fixed any error's that was made by employees.
Compared data with source documents, re-entered data in verification format to detect errors.
Located and corrected data entry errors, and gave feedback to the employee.
Experience
2-5 Years
Level
Executive
Education
BA
Quality Reviewer Resume
Objective : Quality Reviewer is responsible, attention to detail, labor oriented individual seeking entry level position with your company. Learning quickly, works well with others and manages time wisely, Reviewing charts of patients for compliance and reports concerns to the medical staff, Collecting data from medical record for computerized severity adjustment system.
Skills : Microsoft Office Word, Excel and PowerPoint, Tax-wise, Quick-book, TMA System, Individual Tax Planning.
Description :
Reviewed Out of State title cases to ensure all documents are filled out correct.
Located lost documents and match them with the correct vehicle.
St-rived to meet the working excellent number per hour.
Utilised excel to maintain records.
Verified documents and transferring of ownership on both in/out of state car titles.
Ran a cash register, give exact change, balance cash drawer and make deposits.
Provided quality customers service.
Experience
0-2 Years
Level
Entry Level
Education
Bachelor's
Quality Reviewer Resume
Headline : Quality Reviewer is Experienced in electronically reviewing documents in complex litigation matters using our various review platforms including KLDiscovery, Nebula, EDR, and Relativity is preferred but not required, Assisting with quality control, preparation of privilege and redaction logs.
Accomplished through a thorough review of randomly sampled finalized inquiries.
Compiled results and provides regular, objective, and timely assessment of individual, department and corporate performance.
Resolved discrepancies between interviews and case records.
Ensured that the quality program requirements, corporate and departmental policies and procedures are applied properly in the quality review process of customer service inquiries and claim adjustments.
Assisted Supervisor in monitoring and charting the progress of quality reviews.
Completed monthly quality reports, communicates quality performance results and trends routinely at staff meeting and prepares written quality communication to staff as needed.
Maintained inventory.
Experience
5-7 Years
Level
Executive
Education
Certificate In Education
Quality Reviewer Resume
Headline : To secure a Quality Reviewer position that will provide me with challenges that will lead to further personal and professional development. A position that will allow me to demonstrate my talents and capacities and that appreciates a strong work ethic.
Skills : Microsoft Office, Products And Other Database Management Software.
Description :
Completed both Pre-Booking and Post-Close Audits.
Ensured all title/liens were cleared for company to hold secure lien on property.
Read and analysed appraisals, calculated income, garnishments and customer's ability to pay back loan.
Identified all discrepancies to send back for customer to execute within company and state law requirements.
Handled incoming customer service calls from branches in Texas and Oklahoma for Real Estate loans and applied appropriate laws and regulations for each state accordingly.
Authorised release of funds to borrowers based on completion of all requirements.
Distributed mortgage, homeowners insurance and tax payoffs on behalf of the borrower.
Experience
5-7 Years
Level
Executive
Education
High School Diploma
Quality Reviewer Resume
Headline : To secure a full time Quality Reviewer position applying my analytical and leadership abilities obtained from past experience and a strong academic career, Establishing Job Aids and Tools to help aide Customer Service Associates.
Skills : Complex Case Manager, Registered Nurse.
Description :
Maintained logs of activities and completed work.
Accurately collected, verified and updated demographic and insurance information and completes all forms, EVS verification, Medicare Secondary Payer Questionaire, Advance Directive, Patient Rights and consents.
Ensured that all required documentation has been obtained and signed.
Explained medical and financial responsibility to patient.
Determined if an authorisation or referral is required by the insurance plan for service.
Performed ABN screening (if applicable) Contact MD to obtain necessary information, if applicable prior to scheduling elective service.
Ensured Customer Service Representatives are following quality standards by providing feedback on a daily basis and guide new hire employees through the quality process and putting emphasis on the quality standards.
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