Offer summary

Qualifications:

Bachelor's degree in a relevant field such as law, business, or social sciences., Strong analytical and problem-solving skills to assess complex cases., Excellent communication skills for effective client interaction and reporting., Experience in dispute resolution or appeals processes is preferred..

Key responsibilities:

Review and analyze case files to determine the validity of appeals.

Prepare detailed reports summarizing findings and recommendations.

Communicate with clients to gather information and provide updates on case status.

Collaborate with team members to develop strategies for dispute resolution.

Healthcare Quality Strategies, Inc. (HQSI) offers independent medical review services for private and government insurers, hospitals, third-party administrators, and employers. As a URAC-certified organization and a member of NAIRO, HQSI performs reviews across all major medical specialties while upholding the highest ethical and professional standards. HQSI efficiently and accurately conducts reviews in the following areas: • Medical necessity • Appropriateness of setting • Level of care • Quality of care • Experimental treatments/procedures • Coding • DRG assignment With over 25 years of experience in health quality improvement, HQSI collaborates with providers, communities, and government agencies, including the Centers for Medicare & Medicaid Services, to enhance the safety, efficiency, and effectiveness of healthcare.

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