Dane Street

Medical Billing and Coding

• 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

QA Engineer

• 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

Customer Support

• 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.