Dane Street

Operations

• Oversee and ensure the profitability of the regional operations center
• Drive revenue growth by delivering excellent customer service
• Ensure timely delivery of high-quality reports
• Manage client inquiries in a timely manner
• Optimize physician costs and ensure adherence to fee schedules
• Build relationships with key physicians for panel retention
• Monitor key performance metrics of Customer Service Representatives (CSR) and Quality Assurance (QA) Specialists
• Conduct performance evaluations and handle discipline as needed
• Plan and organize daily activities related to production and operations
• Measure productivity by analyzing performance and financial data
• Coordinate with other departments such as HR, finance, and IT

Group Health Operations Manager

Therapist

• Apply physical therapy expertise to conduct comprehensive reviews of clinical cases
• Provide objective, evidence-based opinions related to musculoskeletal conditions and rehabilitative care
• Review medical records and prepare clear and concise clinical summaries
• Respond to specific questions from clients regarding physical therapy treatment, functional outcomes, diagnosis, and medical necessity
• Support high-quality, defensible clinical determinations

Medical Advisory Reviewer – Physical Therapist, Utah Licensed

Medical Advisory Reviewer, Physical Therapist – New Mexico Licensed

• Conduct comprehensive reviews of clinical cases
• Provide objective, evidence-based opinions related to musculoskeletal conditions and rehabilitative care
• Review medical records and prepare clear and concise clinical summaries
• Respond to specific questions from clients regarding physical therapy treatment, functional outcomes, diagnosis, and medical necessity
• Join a team that values clinical judgment and commitment to healthcare assessments

Medical Advisory Reviewer – Physical Therapist, Colorado Licensed

QA Engineer

• The Pharmacy QA Specialist plays a critical role in the pharmacy review process, supporting PBM clients by ensuring the accuracy, completeness, and quality of pharmacy-related determinations and documentation.
• This role is responsible for coordinating with clients, pharmacists, and internal teams to ensure that all reviews are completed in accordance with client requirements, regulatory standards, and turnaround time expectations.
• In addition to standard QA responsibilities, provides subject matter expertise related to pharmacy benefits, medication reviews, and PBM processes, and serves as a resource for non-pharmacy QA staff on medication-related questions.
• Provide regular status updates to PBM clients regarding case progress and completion timelines.
• Evaluate the quality and completeness of pharmacy reviews to ensure alignment with client policies, formularies, and regulatory requirements.
• Ensure that determinations are supported by appropriate clinical and/or formulary rationale.
• Clarify ambiguous or incomplete requests with clients.
• Distribute final determinations in accordance with client-specific requirements.
• Manage and execute clarification and addendum requests from clients.
• Follow up with clients for missing or incomplete information necessary to complete reviews.
• Work directly with pharmacists and/or reviewers to ensure all client questions are addressed accurately.
• Ensure determinations are supported by appropriate clinical guidelines, formulary rules, and PBM policies.
• Conduct follow-ups to ensure timely completion of reviews.
• Provide feedback to pharmacists regarding documentation quality and completeness.
• Issue clarification requests when additional rationale or information is required.
• Ensure final documentation is complete, approved, and properly attributed prior to release.
• Review each case for accuracy, including medication details, dosing, clinical rationale, and documentation quality.
• Ensure compliance with applicable state, federal, and client-specific PBM requirements.
• Verify adherence to client-specific workflows, including prior authorization, appeals, and exception processes.
• Ensure all special handling instructions are followed prior to case release.
• Reliable high-speed internet connection.
• Ability to maintain a secure and uninterrupted work environment.

Pharmacy QA Specialist

IT Support

• Own projects end-to-end: design, development, deployment, and ongoing support
• Build and maintain backend systems and APIs
• Integrate with third-party platforms and external services
• Develop automation workflows to streamline internal processes
• Collaborate with stakeholders to translate business needs into technical solutions
• Manage and prioritize multiple concurrent initiatives in a fast-paced environment
• Contribute to system architecture and technical decision-making

IT Engineer

Analyst

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
• Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
• Input and manage essential clinical details within various medical management platforms.
• Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
• Apply clinical reasoning to determine the suitable evidence-based guidelines.
• Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Quality Analyst, LPN/RN Required

Accounting Manager

• The Senior Accounting Manager will be responsible for managing personnel in the accounting department and performing an array of accounting services including data review, data entry, reconciliation and transaction processing, and numerous other tasks and projects.
• Reconcile financial discrepancies by collecting and analyzing account information.
• Provide financial information in an accurate and timely manner.
• Interpret and apply accounting policies and regulations to ensure compliance.
• Oversee timely month-end financial close process.
• Identify trends, potential cost savings, and opportunities for financial improvements.
• Summarize current financial status by assisting with analysis of general ledger accounts.
• Submission of financial statements in a timely manner.
• Working with operational staff to review P&L and other financial statements to improve profitability of departments.
• Manage financial vendor relationships, such as CPA, banking, etc.
• Work with accounting software to identify areas of better analysis, entries and development to align AccessDS and current software programs.
• Financial Modeling and Forecasting.
• Other duties & special projects, as assigned and based on business needs.

Senior Accounting Manager

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

• 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

• 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.****