Claims Quality Analyst

October 5

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Dane Street

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IMEs • Physician Advisor Reviews • Peer Reviews • Drug Utilization Reviews

51 - 200

Description

JOB SUMMARY • The Quality Analyst is responsible for managing the various aspects of the medical file review process. • They will review the completed referral to ensure client questions have been addressed appropriately and review the completed report for accuracy. • Ensuring client and department standards have been met. MAJOR DUTIES & RESPONSIBILITIES • Quality Audits • Reviews reports accompanying medical records to ensure that the report is complete and that all questions posed by the client have been addressed. • Follows up with the reviewer with any additional questions or clarifications needs. • Follows up with the client should there be any additional questions. • Updates clients frequently on referral progress. • Ensures the report is grammatically correct with no spelling errors. • Ensures each referral adheres to the QA checklist prior to the completion. • Formats reports for approval. • Communication • Communicates clearly and concisely between the customer, reviewer, and Operations team. • Must confidently speak with physicians and clients regarding the content of their peer reviews. • Other duties & special projects, as assigned and based on business needs. EDUCATION/CREDENTIALS: • An Associate’s Degree or Bachelor’s Degree is preferred. JOB RELEVANT EXPERIENCE: • Business experience in a healthcare and/or insurance setting is preferred. • Operations experience with Peer Review, UR and/or case management. • Working with technology based processes within the business environment. JOB RELATED SKILLS/COMPETENCIES: • Present exceptional communication skills with a clear understanding of company business lines. • The ability to apply critical thinking, manage time efficiently and meet specific deadlines. • Computer literacy and typing skills are essential. • Ability to handle high volume and meet deadlines. WORKING CONDITIONS/PHYSICAL DEMANDS: • Any lifting, bending, traveling, etc. required to do the job duties listed above. • Long periods of sitting and computer work. WORK FROM HOME TECHNICAL REQUIREMENTS: • Supply and support their own internet services. • Maintaining an uninterrupted internet connection is a requirement of all work from home position. This job description is subject to change at any time.

Requirements

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. • We offer a range of benefits including medical, dental, and vision coverage for you and your family. • Additionally, we offer voluntary life insurance options for you, your spouse, and your children. • We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. • Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. • Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. • Apple equipment and a media stipend are provided for remote workspace. • ABOUT DANE STREET: • A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. • We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. • We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.