Job Description
JOB SUMMARY
This role supports the Quality Assurance (QA) and Customer Service (CSR) teams by reviewing incoming referrals, pulling applicable clinical guidelines and payer policies, and ensuring all required documentation is complete and accurate. In a fast-paced, high-volume environment, this individual plays a key role in maintaining workflow efficiency, supporting timely intake processing, and identifying and communicating any missing information needed for review.
MAJOR DUTIES & RESPONSIBILITIES
- Identify and pull appropriate clinical guidelines and payer policies to support review workflows
- Support QA and CSR teams with administrative and operational tasks
- Monitor and manage shared inboxes to ensure timely response to emails and intake requests
- Identify missing or incomplete information within referrals and promptly notify CSR and QA teams
- Maintain accuracy and attention to detail in a high-volume, deadline-driven environment
- Collaborate with cross-functional teams to ensure efficient intake and review processes
EDUCATION/CREDENTIALS:
No formal education or credential requirements; relevant experience and skills are strongly considered.
JOB-RELEVANT EXPERIENCE:
Business experience in a healthcare and/or insurance setting is required. Experience with prior authorization, utilization management, or clinical guideline review is preferred.
JOB-RELATED SKILLS/COMPETENCIES:
Ability to work independently and collaboratively within a team environment, with strong time management and prioritization skills. Excellent written and verbal communication, keen attention to detail, and the ability to multitask effectively. Highly organized, adaptable, and proficient in computer applications, including Microsoft Office (Outlook, Excel, and Word).
WORKING CONDITIONS/PHYSICAL DEMANDS:
This position primarily involves sedentary work, including prolonged periods of sitting and computer use. Essential functions may require occasional lifting, bending, and minimal travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
WORK FROM HOME TECHNICAL REQUIREMENTS:
Supply and support their own internet services.
Maintaining an uninterrupted internet connection is a requirement for all work-from-home positions.
This job description is subject to change at any time.
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
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.
