Independent Dispute Resolution Paralegal

Paralegals, claims resolution managers, and administrative law judges with healthcare claims experience are needed! Dane Street is looking for highly motivated paralegals to work in a new dispute resolution program. Pre-legal, professional bill review, claims resolution managers, and administrative law judges all have the skills necessary for this program. Dane Street offers an exciting work environment, competitive compensation, and strong growth potential.

Job Summary :

A new program offering on the group health side of our business enables you to apply, your organizational knowledge to review reports accompanying medical records to ensure that medical billing information and coding are correct. You will communicate with other reviewers and their office teams to ensure clarity of information and ensure all questions posed have been addressed, and ensure that reports are returned within client deadlines.

Core Duties & Responsibilities :

• Evaluates and organizes medical information to ensure that cases are adjudicated properly. The successful candidate will determine whether they meet all established program standards.
• Ensures that the medical records are matched appropriately to documentation, and if not, obtains the correct documentation.
• Participate in training for this position, some training may include arbitration training.
• Read policy guidelines and delineate when criteria are / are not met.
• Evaluates claims for conflict of interest and appropriateness.
• Works within established timeframes set by program parameters.
• Provides strong customer service skills and works closely with clients on a case-by-case basis to provide complete, timely, and error-free quality assurance of cases.
• Provides oversight to cases that are complex and need additional review prior to return to the client.
• Serves as an additional level of QA and clinical knowledge / review for cases with quality Issues.

Requirements

Required Education & Experience :

Required Education & Experience :

Required Skills :

PLEASE BE AWARE : In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

ABOUT DANE STREET (www.danestreet.com) :

A fast-paced, Inc. 500 Company with a high-performance culture, Dane Street 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.

Benefits

We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you are an outstanding candidate for this position, if you thrive in a fast-paced environment, and if you are interested in doing meaningful work that impacts others' lives, then we encourage you to apply.