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Job ID 2116860
Job Description
POSITION SUMMARY
As a key player in our team, you will oversee the quality assurance process, ensuring that Physician reports and the associated medical records are meticulously reviewed for completeness, accuracy, and alignment with medical evidence. Your role is vital to maintaining the high standards that Dane Street is known for.
At Dane Street, our success is built on the collaborative efforts of our talented individuals. We foster a culture of care for our clients, each other, and the organization as a whole. It is essential for everyone to contribute to a positive and productive workplace that drives client satisfaction and exceptional results.
PRIMARY RESPONSIBILITIES
Leadership of QA Team
- Assign appropriate QA personnel to each file, clearly defining responsibilities and workflow within the team.
- Supervise the designated staff and manage the File Review Board, ensuring a prompt and precise review process.
- Provide feedback on board evaluations to management to enhance staff efficiency and performance.
- Identify areas for improvement in staff performance, guiding promotions, coaching, and, if necessary, disciplinary actions.
- Assist in the recruitment of skilled candidates for open QA positions.
Ensuring Adherence to QA Duties
- Follow up with Physicians regarding pending reports.
- Review incoming reports for precision and accuracy.
- Return finalized reports to respective parties promptly.
- Adhere to all client-specific instructions throughout the QA process.
Engagement in Problem Resolution
Collaborate actively with QA teams, physicians, account managers, and relevant stakeholders to resolve issues efficiently.
Communicate with physicians for any additional inquiries and update clients on the status of reports and any delays encountered.
Ensure that referrals align with client-directed Turn Around Time (TAT).
Verify the accuracy of Doctor Payment amounts and Client Invoice amounts once referrals receive approval.
Conduct thorough reviews of reports accompanying medical records, confirming completeness, addressing all queries, and ensuring reports are free of errors.
Support the management team in ensuring timely intake completion.
Act as the primary contact between reviewers, team members, and clients regarding the status and procedures related to files.
Assist with communications directed at requesters concerning any questions or issues that arise.
Perform additional tasks and special projects as necessary based on business requirements.
QUALIFICATIONS
EDUCATION/CREDENTIALS:
Preferably, candidates should hold an Associate’s or Bachelor’s Degree.
RELEVANT EXPERIENCE:
A background in medical peer review or knowledge within the healthcare sector is essential. Experience in healthcare and/or insurance industries is highly desirable.
SKILLS & COMPETENCIES:
Candidates should demonstrate excellent communication abilities, possess a comprehensive understanding of the company’s business lines, and exhibit critical thinking skills. Effective time management and the capability to meet specific deadlines are crucial. Proficiency in computer use and typing is mandatory.
WORKING ENVIRONMENT/PHYSICAL DEMANDS:
Job responsibilities may require lifting, bending, and occasional travel. Expect periods of extended sitting and computer work.
REMOTE WORK REQUIREMENTS:
Candidates must supply and support their own internet services. An uninterrupted internet connection is required for this remote position.
This job description may be updated at any time as per organizational needs.
PERKS & BENEFITS
Join the Dane Street family and enjoy a robust benefits package tailored to promote your health and well-being. We provide comprehensive medical, dental, and vision insurance options for you and your family. Additional voluntary life insurance plans are available for you, your spouse, and your children, alongside a variety of other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance. Basic life insurance, along with short-term and long-term disability coverage, is provided at no additional cost. Our generous paid time off policy ensures you have ample opportunity to unwind, while our 401(k) plan—with company matching—supports your future planning. We equip you with Apple technology and offer a media stipend to enhance your home workspace.
ABOUT DANE STREET:
We are a dynamic, Inc. 500 Company with a performance-oriented culture seeking visionary professionals. Dane Street processes over 200,000 insurance claims annually across major sectors including Workers’ Compensation, Disability, Auto, and Group Health. Our tailored Independent Medical Exams and Peer Review programs empower clients in achieving optimal medical decisions within the claims management framework.