No Surprises Act IDRE Billing & Coding Specialist
We are seeking a No Surprises Act IDRE Billing & Coding Specialist with experience exclusively in Independent Dispute Resolution (IDRE) cases under the No Surprises Act. Candidates must have a deep understanding of IDRE processes and compliance requirements. 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 clinical 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 the appropriateness of codes and determine whether they meet all established program standards.
- Ensures that the medical records are matched appropriately to the codes and if not, obtains them.
- Read & apply policy guidelines and healthcare terminology and delineate when criteria are/are not met.
- Evaluates claims for conflict of interest and criteria 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 clinical 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:
- Must have a CPC, APCC, or DRG coder certification
- Payment integrity or professional bill review experience is strongly preferred.
- Out-of-network bill review experience is a plus.
- Experience working in a remote environment is preferred.
- Experience in a medical office or health care background.
Required Skills:
- Must work with a sense of urgency and meet deadlines.
- Must be self-motivated, with a strong drive for performance excellence.
- Excellent written and verbal communication skills are required.
- Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).
- Attention to detail REQUIRED.
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.
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!
ABOUT DANE STREET
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.
We are seeking a No Surprises Act IDRE Billing & Coding Specialist with experience exclusively in Independent Dispute Resolution (IDRE) cases under the No Surprises Act. Candidates must have a deep understanding of IDRE processes and compliance requirements. 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 clinical 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 the appropriateness of codes and determine whether they meet all established program standards.
- Ensures that the medical records are matched appropriately to the codes and if not, obtains them.
- Read & apply policy guidelines and healthcare terminology and delineate when criteria are/are not met.
- Evaluates claims for conflict of interest and criteria 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 clinical 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:
- Must have a CPC, APCC, or DRG coder certification
- Payment integrity or professional bill review experience is strongly preferred.
- Out-of-network bill review experience is a plus.
- Experience working in a remote environment is preferred.
- Experience in a medical office or health care background.
Required Skills:
- Must work with a sense of urgency and meet deadlines.
- Must be self-motivated, with a strong drive for performance excellence.
- Excellent written and verbal communication skills are required.
- Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).
- Attention to detail REQUIRED.
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.
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!
ABOUT DANE STREET
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.
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