Job Listings
IME Claims Quality Analyst PNW
IME Pacific NorthwestFederal Way, WA, USA
Dane Street is looking for highly motivated candidates to join our IME team as a Quality Analyst. Dane Street offers an exciting work environment, competitive compensation and a strong growth potential.
A Quality Analyst is in the center of our critical relationships with our clients, our technical team and our operations teams. As a member of our team, you will be responsible for reviewing IME and Peer Review reports for accuracy.
Required Minimum Education:
- High school diploma required.
- Associates Degree preferred.
Description of Key Tasks and Responsibilities:
- Reviews reports accompanying medical records to ensure that the report is complete and that all questions posed have been addressed.
- Follows up with the reviewer with any additional questions or need clarification.
- Evaluate physician specialty assignment and guidelines application based on guidelines or assist in the analysis of IME cases.
- Communicate inconsistencies and/or inaccuracies based on medical documentation and/or state guidelines.
- Follows up with IME/Peer Review provider to ensure that the report is received back for QA within the specified time-line set forth by the referrer.
- Follows up with the referrer should there be additional questions or if the report will be delayed.
- Improve team's competence by providing resources; balancing file requirements within the client specifications all within company procedures and guidelines.
- Provide new hire QA training.
Special Skills and Attributes:
- Ability and confidence to speak with physicians and clients regarding the content of their medical peer reviews.
- Previous experience with peer review/case management is preferred.
- Experience as a claims adjuster within the insurance/medical industry, auto, worker's compensation, nursing (LPNs or RNs) or work with an IME company a plus.
- Claims/Medical Terminology background.
- Ability to learn quickly.
- Ability to research and document clearly is essential to the success of this position.
- Excellent computer skills are required.
- Excellent organizational skills are essential, including the ability to manage time efficiently and to meet specific deadlines.
- Excellent communication and grammar skills are a must.
- The ability to work independently and make critical decisions is essential.
- The exercise of discretion and independent judgment with respect to matters of significance.If you want to work in an exciting, growing environment, where you can provide meaningful contributions, we encourage you to apply.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute 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 Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
To apply:
Jade Edwards
Corporate HR Recruiter
Dane Street, LLC
7121 Fairway Drive • Suite 102 • Palm Beach Gardens, FL • 33418
O: 561-345-7644
Posted July 23, 2018
IME Claims Customer Service Representative PNW
IME Pacific NorthwestFederal Way, WA, USA
Dane Street is looking for highly motivated candidates to join our team as aCustomer Service Representativein our Federal Way, WA office. Dane Street offers an exciting work environment, competitive compensation and a strong growth potential.
A Customer Service Representativeis in the center of our critical relationships with our clients, our technical team and our operations teams. As a member of our team, you will be responsible for the scheduling and selection of reviewers for referrals received within the Dane Street Network.
Required Education and Experience:
- A graduate of an accredited High School program or equivalent required.
- Medical training from an accredited Technical or College program is preferred.
- 1 year of experience in a Customer Service/Administrative role in a business office environment.
Description of Key Tasks and Responsibilities:
- Schedules IMEs (independent medical examinations) in accordance with Dane Street’s regulatory state guide.
- Physician Schedulers must comply with each client's special handling, instructions, wants and needs.
- Understanding of referral types required. Know what each referral type means, ex. initial review, appeals, reconsiderations.
- Schedule reviewers of the appropriate specialty and state license match per state regulations.
- Review upcoming scheduled IMEs and ensure the physicians have all materials needed for the exam(s).
- Make reminder calls to claimants and provide them with IME details.
- Send reminder e-mails to the Reviewers on their assigned cases and the due dates.
- Promptly communicate any changes, delays or other necessary information to clients.
- Other duties as assigned.
Special Skills and Attributes:Required:
- Customer service skills and experience.
- Excellent computer skills (Apple Operating System, Google Chrome search engine and gmail preferred).
- Ability to communicate effectively with remote team members and/or external contacts.
- Excellent negotiation skills.
- Attention to detail.
- Critical thinking.
- The ability to manage time efficiently and to meet specific deadlines.
Preferred:
- Experience with physician networks, recruitment, medical specialties and terminology, medical claims, medical office, and/or industry knowledge.
- Knowledge of relevant State and Federal compliance guidelines.
About Dane Street:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute 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 Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
To apply:
Jade Edwards
Corporate HR Recruiter
Dane Street, LLC
7121 Fairway Drive • Suite 102 • Palm Beach Gardens, FL • 33418
O: 561-345-7644
Posted July 23, 2018
Submit a Job Listing
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