Peer/Record Review Quality Analyst

🕒 Junho 15

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Dane Street

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

📋 Conformidade

🏛️ Governo

Healthcare Insurance • Compliance • Government

A Dane Street é líder nacional em Exames e Revisões Médicas Independentes, fornecendo Exames Médicos Independentes (IMEs), Revisões por Pares e outros laudos médicos de forma objetiva, em conformidade e dentro dos prazos. Com uma ampla rede de mais de 16. 000 médicos, a empresa oferece serviços em 25. 000 localidades e 100 especialidades, incluindo sinistros de compensação trabalhista (Workers’ Compensation), automóvel, responsabilidade civil (Liability) e incapacidade (Disability). A Dane Street atende seguradoras, Third-Party Administrators (TPAs), organizações de Managed Care e órgãos federais/estaduais com análises médicas especializadas, ajudando-os a tomar decisões precisas. A empresa é reconhecida pela qualidade, prazos de entrega ágeis e processos eficientes, tendo conquistado credenciais como a Acreditação da NCQA em Utilization Management e a certificação Great Place to Work.

Descrição

• Managing the various aspects of the medical file review process • Reviewing the completed referral to ensure client questions have been addressed appropriately • Reviewing the completed report for accuracy • Ensuring client and department standards have been met • Conducting quality audits • Following up with the reviewer with any additional questions or clarifications needed • Following up with the client should there be any additional questions • Updating clients frequently on referral progress • Ensuring the report is grammatically correct with no spelling errors • Ensuring each referral adheres to the QA checklist prior to completion • Formatting reports for approval • Communicating clearly and concisely between the customer, reviewer, and Operations team • Confidently speaking with physicians and clients regarding the content of their peer reviews.

🎯 Requisitos

• An Associate’s Degree or Bachelor’s Degree is preferred • Business experience in a healthcare and/or insurance setting is preferred • Working with technology based processes within the business environment • Present exceptional communication skills with a clear understanding of company business lines • The ability to apply critical thinking, manage time efficiently and meet specific deadlines • Computer literacy and typing skills are essential • Any lifting, bending, traveling, etc. required to do the job duties listed above • Long periods of sitting and computer work • Supply and support their own internet services • Maintaining an uninterrupted internet connection is a requirement of all work from home position

🏖️ Benefícios

• medical, dental, and vision coverage for you and your family • voluntary life insurance options for you, your spouse, and your children • other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans • basic life insurance • short-term disability • long-term disability coverage at no cost • generous paid time off policy • 401k plan with a company match • Apple equipment and a media stipend for remote workspace