Peer/Record Review Quality Analyst

JOB SUMMARY

The Peer / Record Review Quality Analyst is responsible for managing the various aspects of the medical file review process. They will review the completed referral to ensure client questions have been addressed appropriately and review the completed report for accuracy. Ensuring client and department standards have been met.

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

Quality Audits

Reviews reports accompanying medical records to ensure that the report is complete and that all questions posed by the client have been addressed.

Follows up with the reviewer with any additional questions or clarifications needs.

Follows up with the client should there be any additional questions.

Updates clients frequently on referral progress.

Ensures the report is grammatically correct with no spelling errors.

Ensures each referral adheres to the QA checklist prior to the completion.

Formats reports for approval.

Communication

Communicates clearly and concisely between the customer, reviewer, and Operations team

Must confidently speak with physicians and clients regarding the content of their peer reviews.

Other duties & special projects, as assigned and based on business needs.

Requirements

• EDUCATION/CREDENTIALS: An Associate’s Degree or Bachelor’s Degree is preferred.
• JOB RELEVANT EXPERIENCE: Business experience in a healthcare and/or insurance setting is preferred.
• Working with technology based processes within the business environment.
• JOB RELATED SKILLS/COMPETENCIES: 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.
• WORKING CONDITIONS/PHYSICAL DEMANDS: Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.
• WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services.
• Maintaining an uninterrupted internet connection is a requirement of all work from home position.
• This job description is subject to change at any time.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful 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 Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.