Physician Advisory Services - QA Specialist

November 7

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Dane Street

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

51 - 200 employees

⚕️ Healthcare Insurance

📋 Compliance

🏛️ Government

Description

• JOB SUMMARY • The QA Specialist plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is delivered by the customer requested due date. • The QA Specialist is responsible for the timely completion and overall completeness of a reviewer report. • Completeness is determined by customer requirements, company best practices, and clinical accuracy. • In addition, the QA Specialist participates in improving DS processes and works with the Manager to ensure high efficiencies are achieved. • Dane Street’s success relies on individual and team contributions every day. • We care for our customers, each other and Dane Street. • It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results. • MAJOR DUTIES & RESPONSIBILITIES. • Client Interaction • Provides regular report status updates to the client. • Evaluates the Quality of physician’s report and determines if the report will meet all client and jurisdictional standards; the QA Specialist is also responsible for ensuring that the clinical rationale supports the physician’s determinations. • Clarifies ambiguous report questions with clients. • Distribute final report back to client according to client specific requirements. • Receives, coordinates & executes all aspects of clarification & addendum requests from the client. • Participates in phone calls OR meetings with client(s) when a report is in question. • Follow up with the client for any missing information that is pertinent to the referral. • Physician Interaction • Works directly with physicians to ensure that all client questions are answered and supported by clinical rationale. • Conduct regular follow up with the physician or their office staff to ensure an on-time delivery of the report. • Compose and provide verbal or written feedback to the doctor regarding report quality. • Compose and provide verbal or written requests to the physician or their office staff for clarifications. • Receive written or verbal confirmation from the physician that a report has the doctor’s approval and ensures the doctor provides his/her signature for the final report. • Report Analysis • Review each physician report for data accuracy including spelling, grammar & punctuation. • Responsible for ensuring that all state requirements for reporting are met. • Responsible for report format and adhering to each client’s specific requirements. • Must ensure that all client special handling instructions with regard to report completion and delivery are met. • Additional Duties • May provide oversight to the work of the team members. • Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction. • Responsible for the final approval on cases for release to the client. • Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

Requirements

• 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. • 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. • 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.

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. • 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.