Dane Street is looking for a highly motivated candidate with experience working with Texas Worker’s Compensation Claims to join our IME team as a Quality Analyst. This is a remote opportunity, and although we are looking for someone with experience with Texas WC Claims, the candidate does not need to be sitting in Texas.
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.
- Must have TX Workers Compensation Experience
- 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.
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.