Dane Street

Customer Support

• Intake new cases and review/verify information and requests.
• Draft cases by entering information into the Dane Street system, AccessDS.
• Work with the client on any information missing pertinent to processing the claim.
• Monitor, process and track cases to ensure we meet deadlines.
• Assign/schedule new cases to physicians for review.
• Update clients frequently on cases in progress.
• Ensure proper documentation for specified cases is provided to the client.

Disability Customer Service Representative

Operations

• Utilize clinical expertise to review medical records provided and return an independent, professional opinion on the claimant’s functionality and restrictions or limitations as it relates to an application for disability benefits or the current status of disability.
• Determinations are based on the clinical evidence within the medical records provided.

Neuropsychology Physician Advisor – Disability Peer Reviewer

QA Engineer

• The Clinical QA Supervisor is responsible for the oversight of the review of Physician reports and accompanying medical records to ensure that the report is complete, accurate, and consistent with medical evidence.
• Oversight of QA staff
• - Ensure appropriate QA staff are assigned to each file to designate file handling responsibilities amongst the team.
• - Supervise the assigned staff and manage the File Review Board to ensure a timely and accurate process of each file.
• - Provide details of board reviews to managers to ensure efficiency and productivity of staff.
• - Assist in identifying & correcting staff performance including promotions, discipline, coaching and termination of staff.
• - Assist in hiring qualified candidates for QA open positions.
• Ensure that all QA staff adhere to and meet their specific job duties including but not limited to:
• - Following up with Physicians for outstanding reports
• - Reviewing received reports for accuracy
• - Delivering completed reports back to all applicable parties
• - Following all client-specific instructions
• - Actively participate in issue resolution by working with the required QA, physicians, account managers, and/or other related parties.
• - Ensure referrals meet the client-directed Turn Around Time (TAT).
• - Act as the liaison between the reviewer, team member and client regarding the process or status of the file.
• - Other duties & special projects, as assigned and based on business needs.

Group Health Clinical QA Supervisor

• The Customer Service Representative is responsible for the receipt of new cases and ensuring proper system drafting and setup.
• The CSR is also responsible for taking direction and facilitating the case assignment/scheduling process.
• Intake new cases and review/verify information and requests.
• Draft cases by entering information into the Dane Street systems.
• Work with the client on any missing information pertinent to processing the claim.
• Sort, organize, and create a medical document listing, if required by the client, in line with specific special handling.
• Respond to inbound calls, emails, and portal inquiries.
• Maintain efficient and accurate records related to all client interactions.
• Ensure compliance with Federal NSA regulations, processes, and policies.
• Collaborate with the Leadership team and other departments to ensure timely resolutions.
• Assign/schedule new cases to physicians for review with the appropriate physician, based on location, reviewer availability, specific guidelines, jurisdictional requirements and other client requirements.
• Monitor, process, and track cases to ensure we meet deadlines.
• Update clients frequently on cases in progress.
• Ensure proper documentation for specified cases is provided to the client.
• Maintain consistent professionalism at all times.

Government Customer Service Representative

Medical Billing and Coding

• Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)
• Conduct utilization reviews to assess medical necessity and documentation compliance
• Review and prepare demand packages for personal injury and insurance cases
• Analyze medical records for payer disputes, recoupments, and appeals
• Prepare detailed, defensible written audit reports
• Provide expert review, affidavit support, deposition preparation, and testimony when required
• Interpret CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer rules
• Review E/M services under 2021+ guidelines
• Identify compliance risks and documentation deficiencies

Coder, Bill Audit Reviews

• Perform detailed medical coding audits (ICD-10-CM, CPT, HCPCS)
• Conduct utilization reviews to determine medical necessity and documentation compliance
• Review and prepare demand packages and audit response materials
• Analyze records for payer disputes and recoupments
• Prepare written audit findings and defensible reports
• Provide expert support for depositions and testimony as needed
• Review E/M services under 2021+ guidelines
• Interpret CMS, LCD/NCD, and payer-specific policies
• Identify risk areas and compliance vulnerabilities

Coder – Counter Affidavit & Auditing

Attorney

• **JOB SUMMARY**
• The Legal Specialist supports the daily processes required for compliance with government regulations and client specifications, including accreditation. The position requires research of legislation, regulation, and guidance affecting the health care, insurance, and related industries. Assistance with monitoring internal training requirements and assistance with security protocols is regularly performed. The Legal Specialist will assist with the review of contracts as requested, including proofreading, suggested edits, and potential issue spotting. Assistance with responding to routine legal inquiries will occur regularly.
• 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**
• - Licensure Applications: Provides assistance with assembly and submission of applications to state agencies for the granting or extension of state licensures, registrations, or other authorizations to conduct medical review activities.
• - Legal Research: Gather, analyze, and summarize statutory, legislative, and background information on laws or regulatory guidance affecting Dane Street.
• - Proofreading: Assisting the Vice President of Legal, Compliance and Regulatory Affairs or other personnel with the review of contracts and other prepared documents.
• - Ad Hoc Projects: Leading or assisting with projects that arise involving an aspect of Dane Street’s business, including data gathering, research, or presentation production.
• - Internal Data Tracking: Examples include review for expirations/auto renewals of contracts and discussion with the Vice President for any necessary action, tracking and updating of insurance data, assistance with certificate of insurance (COI) requests, updating certificate of authority expirations, and updating statistical data.
• - URAC Assistance: Cite checking, proofreading, document management and preparation, and policy research.
• - Web Based Training Compliance: Assistance with alerting applicable staff of required training and ensuring participation and completion of training.
• - Committee Participation: Includes Quality Management Committee and roles including taking minutes, issuing follow-up messages and reminders to the other members of the committees and tracking progress on committee projects.
• - Security Incidents: Assist in documenting and tracking information breach and other security incidents posing potential compliance exposure to Dane Street.
• - Draft objections and other responses to routine subpoenas.
• - Legal writing skills are required, including the use and understanding of standardized citations (e.g. MLA or Bluebook) of cases, statutes, regulations, and secondary legal sources.
• - Provide routine Legal & Compliance department responses for interdepartmental projects (e.g. RFIs and RFPs).
• - Review and, as needed, provide revision suggestions for company policies.
• - Assistance with routine Credentialing requests for Legal and Compliance input or decisions.
• Other duties & special projects, as assigned and based on business needs.****

Legal Specialist

• Conduct comprehensive utilization reviews to determine medical necessity and level of care
• Review medical records for documentation completeness and clinical appropriateness
• Evaluate inpatient, outpatient, and procedural services for compliance with payer guidelines
• Assist with preparation and review of demand packages for legal and insurance cases
• Analyze cases involving payer disputes, denials, and recoupments
• Prepare detailed, defensible written clinical review reports
• Provide affidavit support, deposition preparation, and testimony when required
• Interpret CMS guidelines, Medicare policies, and state-specific Medicaid requirements
• Identify clinical risk, quality-of-care concerns, and documentation deficiencies

RN Coder, Registered Nurse

Therapist

• Apply expertise to conduct comprehensive reviews of clinical cases
• Provide objective, evidence-based medical opinions
• Review medical records and prepare clear and concise clinical summaries
• Respond to specific questions from clients related to physical therapy care

Medical Advisory Reviewer – Physical Therapy

Account Manager

• Dane Street is a leading provider of IME and Peer Review Services to the Disability, Workers’ Compensation, Auto, and Group Health marketplaces.
• **We are seeking a strong contributor to join our Disability National Account Management Team. The candidate must possess the right balance of relationship-building skills, problem-solving and analytical abilities, and business development experience to significantly impact Dane Street’s existing book of business.
• 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.
• The National Account Manager is responsible for both retaining and expanding existing client relationships while also proactively generating new business opportunities through outreach, referrals and consultative sales efforts. This role combines strategic account management with business development to drive revenue growth.
• **MAJOR DUTIES & RESPONSIBILITIES**
• The National Account manager will have the support of the entire organization to retain and grow Dane Street’s existing clients:
• - Identify and pursue new revenue opportunities within existing and new accounts
• - Working with Dane Street’s Director of Operations, QA Staff and Business Analyst team to ensure client satisfaction and effective problem resolution
• - Developing strong Manager/Requester and Senior Leadership relationships across Dane Street’s accounts
• - Generating strong goodwill within the existing account user base
• - Creating and executing a strategic account plan for all Dane Street clients
• - Growing revenue and referral volume within all top target accounts
• - Proactively identify risks and resolve client concerns
• - Conduct outreach to prospective clients through networking, referrals and targeted prospecting
• - Provide weekly reporting on account health, growth opportuniries and sales activities
• - Support special projects and cross-functional initiatives as needed

Disability Sales & Account Manager

• 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.
• 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.
• 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.
• 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.
• 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.

Physician Advisory Services – QA Specialist

• Handling Receipt of New Cases:
• Intake new cases and review/verify information and requests. Draft cases by entering information into the Dane Street system, AccessDS.
• Work with client on any information missing pertinent to processing claim.
• Sort, organize and create medical document listing - if required by client, and in line with specific special handling.
• Oversight of Cases:
• Monitor, process and track cases to ensure we meet deadlines.
• Assignment of Cases:
• Assign/schedule new cases to physicians for review with the appropriate physician, based on location, reviewer availability, specific guidelines, jurisdictional requirements and other client requirements.
• Ensure that the assigned physician has no conflict of interest with the case assignments
• Client Interaction:
• Update clients frequently on cases in progress.
• May communicate when there are questions on referral information to ensure proper documentation and information is provided to the assigned reviewer.
• Ensure proper documentation for specified cases is provided to the client.

Group Health Customer Service Representative

• Identify and pursue new revenue opportunities within existing and new accounts • Working with Dane Street’s Director of Operations, QA Staff and Business Analyst team to ensure client satisfaction and effective problem resolution • Developing strong Manager/Requester and Senior Leadership relationships across Dane Street’s accounts • Generating strong goodwill within the existing account user base • Creating and executing a strategic account plan for all Dane Street clients • Growing revenue and referral volume within all top target accounts • Proactively identify risks and resolve client concerns • Conduct outreach to prospective clients through networking, referrals and targeted prospecting • Provide weekly reporting on account health, growth opportuniries and sales activities • Support special projects and cross-functional initiatives as needed

Disability National Account Manager

• Intake new cases and review/verify information and requests.
• Draft cases by entering information into the Dane Street system, AccessDS.
• Work with client on any information missing pertinent to processing claim.
• Sort, organize, and create medical document listing - if required by client, and in line with specific special handling.
• Assign/schedule new cases to physicians for review with the appropriate physician.
• Monitor, process, and track cases to ensure we meet deadlines.
• Update clients frequently on cases in progress.

Customer Service Representative

Auditor

• **MAJOR DUTIES & RESPONSIBILITIES**
• - Onboard and train all new QA hires.
• - New QAs will be ready for integration into the ops team when the following criteria are met
• - Collaborate on the review of daily operational reports (e.g., outcome reports, TAT, operational synopsis, employee goals).
• - Serve as a resource for team members regarding operational questions, concerns, and problem-solving.
• - Provide backup support to QA Supervisors as needed (e.g., invoicing, board balance).
• - Maintain weekly clarification tracker; identify QAs with opportunities for additional training or feedback.
• - Participate in client calls.
• - Lead bi-weekly Clarification/TAT review meetings: pull data, facilitate discussions, and issue remediation plans.
• - Conduct regular MFR (member-friendly rationale) Workshop training sessions.
• - Develop onboarding agendas in consultation with Ops Leadership.
• - Identify and schedule training opportunities/meetings.
• - Coordinate and track annual client regulatory training requirements.
• - Update and maintain severity and client-change trackers.
• - Create and maintain training documentation.
• - Collaborate on remediation plans for employees.
• - Provide reviewer training when a Medical Director is unavailable; escalate issues to Medical Directors when appropriate.
• - Partner with managers and supervisors to support 90-day reviews, annual evaluations, and PIPs.
• Performance Metrics:
• - Audit Success: Measured by clarification rates, audit results, and daily/monthly TAT.
• - Remediation Effectiveness: Measurable performance improvement within defined timelines
• - Training Success: Evaluated through 90-day and annual employee reviews, and check-ins with new hires (daily, weekly, monthly).
• Other duties & special projects, as assigned and based on business needs.
• ****