Dane Street, LLC

Role Description The Group Health Training and Auditing Specialist (GH Trainer) is responsible for delivering structured training and ongoing education to new hires and current staff, while identifying opportunities for learning, growth, and remediation. This role plays a critical part in improving employee performance, job satisfaction, and client outcomes by monitoring trends such as clarifications, turnaround times (TAT), and overturn rates. - Onboard and train all new QA hires. - New QAs will be ready for integration into the ops team when the following criteria are met: - Proficiency on one core client (≤ 2% clarification rate) - Division 1: HCSC - Division 2: BCBS MN - Division 3: Optum - Daily output of ≥ 5 cases - Collaborate on the review of daily operational reports (e.g., outcome reports, TAT, operational synopsis, employee goals). - Serve as a resource for team members regarding operational questions, concerns, and problem-solving. - Provide backup support to QA Supervisors as needed (e.g., invoicing, board balance). - Maintain weekly clarification tracker; identify QAs with opportunities for additional training or feedback. - Participate in client calls. - Lead bi-weekly Clarification/TAT review meetings: pull data, facilitate discussions, and issue remediation plans. - Conduct regular MFR (member-friendly rationale) Workshop training sessions. - Develop onboarding agendas in consultation with Ops Leadership. - Identify and schedule training opportunities/meetings. - Coordinate and track annual client regulatory training requirements. - Support regulatory accreditation audits (e.g., NCQA, URAC). - Provide backup support to GH Auditor in performing client collaboration audits (e.g., BCBSMN monthly, HCSC quarterly and annual). - Update and maintain severity and client-change trackers. - Create and maintain training documentation. - Collaborate on remediation plans for employees. - Provide reviewer training when a Medical Director is unavailable; escalate issues to Medical Directors when appropriate. - Partner with managers and supervisors to support 90-day reviews, annual evaluations, and PIPs. Performance Metrics: - Audit Success: Measured by clarification rates, audit results, and daily/monthly TAT. - Remediation Effectiveness: Measurable performance improvement within defined timelines. - Training Success: Evaluated through 90-day and annual employee reviews, and check-ins with new hires (daily, weekly, monthly). Other duties & special projects, as assigned and based on business needs. Qualifications - RN or LPN license required. - Strong background in clinical operations, training, or quality assurance. - Extensive experience in utilization review, with a strong background in health plan practices. - Experience navigating CMS requirements, health plan criteria, and nationally recognized guidelines such as MCG and InterQual. - Proficient in rationale writing and translation to patient-friendly language. - Excellent communication, coaching, and mentoring skills. - Ability to analyze data and identify trends to drive performance improvements. - Skilled in client collaboration and escalation management. - Proficiency with Google Suite, communication platforms, and related applications. Requirements - Preferred Experience Includes: - Benefit Denials - Medical Necessity Reviews - EIU Reviews - Criteria-Only Reviews - Formulary Exception Reviews - Quantity Limit Reviews - Step Therapy Reviews - Inpatient vs Observation Reviews - Level of Care Reviews - Claims Reviews - Payment Integrity Reviews - DRG Validation - Quality of Care Reviews - Fraud, Waste, and Abuse (FWA) Reviews Benefits - Comprehensive benefits package including medical, dental, and vision coverage for you and your family. - Voluntary life insurance options for you, your spouse, and your children. - Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans. - Basic life insurance, short-term disability, and 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.

Role Description Dane Street wants you to join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct thorough reviews of clinical cases. This telework opportunity allows you to customize your schedule as a 1099 independent contractor. - Evaluate medical records - Provide clinical summaries - Engage in peer communications - Answer specific questions posed by clients We are on the lookout for talented professionals in the following area: - Pain Medicine Be a part of a team that values your skills and dedication to improving patient care. Your expertise is vital to helping us deliver high-quality healthcare assessments. Qualifications - Board Certified in Pain Medicine - Current, unrestricted Indiana Medical License - 5+ years of clinical practice experience Requirements - Attends all required orientation and training - Maintains proper credentialing, state licenses, and any certifications or requirements necessary to perform the job - Independent consultant role allows for schedule flexibility and predictable work hours - No doctor/patient relationship is established, and no treatment is provided; these are advisory-only opinions Benefits - Streamlined case flow and a user-friendly work portal - Facilitated communication and organized medical records - Support for all administrative processes - Extensive case preparation and quality assurance for timely delivery of determinations/reports - A chronological listing of medical records and treatment guidelines provided in an easy, click-to-view format - Initial training and ongoing point of contact for questions about completing reviews

Role Description Dane Street wants you to join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct thorough reviews of clinical cases. This telework opportunity allows you to customize your schedule as a 1099 independent contractor. Your main tasks will include: - Evaluating medical records - Providing clinical summaries - Engaging in peer communications - Answering specific questions posed by our clients We are on the lookout for talented professionals in the following area: - Hematology/Oncology Be a part of a team that values your skills and dedication to improving patient care. Your expertise is vital to helping us deliver high-quality healthcare assessments. Qualifications - Board Certified in Hematology/Oncology - Current, unrestricted Indiana Medical License - 5+ years of clinical practice experience Requirements - Attends all required orientation and training - Maintains proper credentialing, state licenses, and any certifications or requirements necessary to perform the job Benefits - Independent consultant role allows for schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct this work based on your scheduled availability - No doctor/patient relationship is established, and no treatment is provided; these are advisory-only opinions - Dane Street offers a streamlined case flow and a user-friendly work portal - We facilitate all communication, organize and sort all medical records, support all administrative processes, prep cases extensively, and ensure the quality and timely delivery of all determinations/reports - A chronological listing of medical records as well as all treatment guidelines used to make a determination are provided in an easy, click-to-view format - Dane Street offers initial training as well as an ongoing point of contact should you have any questions about completing reviews

Role Description The Customer Service Representative Administrator will be responsible for overseeing the administrative duties that are related to the customer service process. 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. - Draft incoming referrals including demographic information, diagnosis, requested due date, and specialty within a timely manner of receipt. - Correctly & accurately complete the intake process by closing the intake according to proper workflow procedures. - Filter through client emails throughout an 8-hour workday providing necessary information to the appropriate referral while also delegating/escalating emails to the appropriate team member. - Assist with Dane Street’s “Intake” to ensure that incoming referrals, records, fee schedules, etc. is uploaded into the respective case timely and with the appropriate notifications made. - Handle outreach emails/calls to clients in order to obtain the necessary information and/or medical records for the case to ensure proper handling. - Requesting and pulling medical records from client platforms such as iCase and uploading them to the respective referrals. Notify the CSR team once medical records are received. - Selecting and assigning incoming referrals. Ensuring the Queues are evenly distributed between CSR’s and QA’s. - Invoicing referrals on the CSR and QA board based on the confirmed physician’s fees and client quotes. - Assisting in auditing referrals with upcoming due dates to ensure the case was processed correctly. - Assisting with physician outreaches and referral assignments when team members are on PTO. - Other duties & special projects, as assigned and based on business needs. Qualifications - An Associate’s Degree or Bachelor’s Degree is preferred. Requirements - Business experience in a healthcare and/or insurance setting is preferred. - 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. Benefits - Medical, dental, and vision coverage for you and your family. - Voluntary life insurance options for you, your spouse, and your children. - Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans. - Basic life insurance, short-term disability, and 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. Company Description 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.

Role Description The Credentialing Assistant is responsible for screening reviewers for required credentialing and background information, including professional sanctions and criminal background information. The position requires coordination between multiple departments at Dane Street to provide support relating to the information, data, and standards involved in reviewer credentialing. 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. Qualifications - An Associate’s Degree or Bachelor’s Degree is preferred. - Credentialing experience in a healthcare or insurance setting preferred. - Knowledge of URAC and relevant State and Federal guidelines. - Excellent communication skills as well as understanding of medical terminology. - Critical thinking, ability to manage time efficiently and to meet specific deadlines. - Computer literacy and typing skills required. Requirements - Initial Credentialing: - Enters reviewer application data. - Performs online searches of reviewers. - Conducts primary source verification of reviewer board certifications, licenses, background checks, and malpractice checks. - Uploads documents to the electronic reviewer file. - Produces Judgments page to include comments from the Medical Director. - Applies client Do Not Use status as required. - Communicates the application status with the Operations team, including when an application is denied by the Medical Director. - Recredentialing of Reviewers: - Sends applications to reviewers. - Conducts prime source verification of board certifications, licenses, and malpractice checks. - Performs online searches of reviewers. - Refers reviewers with “red flags” to the Medical Director for review. - Indicates Do Not Use status and Medical Reviewer comments in Judgments document. - Updating Expired Licenses, Board Certifications, and Workers’ Compensation Registration: - Reviews licenses, certifications, and registrations for expiration status. - Exclusions, Preclusions, Background and Sanction Checks: - Creates and receives sanctions check clearinghouse reports and searches for each sanction identified. - Finds supporting documentation, including court documents or National Practitioner Data Bank reporting. - Sends information to the Medical Director for review. - Reactivating, Deactivating, Do Not Use, Reviewer Contact Data and W9 Requests: - Obtains W-9 documents in response to address changes. - Clones profiles in the event of a fundamental identifying data change. - Removes reviewers from the panel based on client or Operations department requests. - Editing Fee Schedules: - Performs data entry of new fees or updated fees. - Obtains new fee agreements as appropriate. - Participation on the Quality Management Committee: - Participates in the Quality Management Committee meetings, which is required by URAC but incorporates Dane Street quality improvement functions. - Participation includes requested follow up activities. - Assist Dane Street Team Members with Credentialing Content: - Provides credentialing related advice to leadership and for contracting and Operations functions. - Other duties & special projects, as assigned and based on business needs. Benefits - Comprehensive benefits package designed to support your well-being and peace of mind. - Medical, dental, and vision coverage for you and your family. - Voluntary life insurance options for you, your spouse, and your children. - Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans. - Basic life insurance, short-term disability, and 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.

Role Description The Healthcare Operations Coordinator is responsible for transferring referral, case, and review data between internal systems and client portals to support daily operational workflows. This role ensures timely, accurate, and compliant handling of case information, documentation uploads, status updates, and portal management activities across multiple client accounts. The position plays a critical role in maintaining operational efficiency, meeting turnaround time requirements, and ensuring data integrity. Key Responsibilities - Portal & Case Management - Upload and download referral documentation, medical records, reports, and supporting materials through client portals and internal systems. - Transfer case information accurately between platforms while maintaining data integrity. - Monitor client portals for new assignments, updates, requests, and status changes. - Verify completeness and accuracy of referral information before processing. - Track and document case movement throughout the workflow lifecycle. - Escalate urgent issues, missing documentation, or portal access concerns to leadership as appropriate. - Data Entry & Documentation - Perform high-volume data entry with strong attention to detail and accuracy. - Maintain organized electronic records and audit trails. - Update internal tracking systems with current case statuses and required documentation. - Ensure all portal submissions meet client-specific formatting and submission requirements. - Conduct quality checks to identify discrepancies or incomplete information prior to submission. - Operational Support - Support Operations Managers and team leadership with administrative workflow tasks. - Assist with reconciliation activities and operational reporting as assigned. - Help monitor turnaround times and identify potential workflow delays. - Communicate professionally with internal teams regarding case status, portal issues, and workflow needs. - Follow all internal SOPs, compliance standards, and client-specific processes. - Quality & Compliance - Maintain confidentiality and securely handle sensitive and protected information. - Adhere to HIPAA and company privacy/security requirements. - Ensure work products meet internal quality standards and productivity expectations. - Performance Metrics - Accuracy of data transfer and portal submissions. - Adherence to turnaround time (TAT) requirements. - Productivity and volume expectations. - Quality audit outcomes and error rates. Qualifications - High school diploma or equivalent required. - Previous administrative, operations, data entry, or healthcare support experience preferred. - Strong attention to detail and organizational skills. - Ability to manage repetitive tasks with consistency and accuracy. - Strong written and verbal communication skills. - Ability to work independently in a remote environment. - Strong time management and prioritization abilities. Preferred Qualifications - Experience working with client portals, EMRs, claims systems, or web-based workflow platforms. - Healthcare, insurance, or medical records experience preferred. - Familiarity with HIPAA and handling confidential information. - Experience in high-volume, deadline-driven operational environments. Technical Skills - Proficiency with Google Workspace and Microsoft Office applications. - Comfortable navigating multiple web-based systems simultaneously. - Strong typing and data entry skills. - Ability to learn client-specific portals and workflow systems quickly. Work Environment - Remote work from home. - Hourly, non-exempt position. - Occasional overtime may be required based on operational needs. Benefits - Comprehensive benefits package including medical, dental, and vision coverage for you and your family. - Voluntary life insurance options for you, your spouse, and your children. - Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans. - Basic life insurance, short-term disability, and 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.

Role Description Perform and manage Human Resources initiatives and functions in order to support employees, customers and overall business needs. This role will play a key part in driving satisfaction and achieving results, with a strong focus on learning and development. - General HR duties including but not limited to payroll, benefits administration, HRIS maintenance, and LOA administration. - Assists with the recruiting process, including locating qualified candidates through various methods of sourcing and networking. - Meet staffing goals through interviewing, evaluating, scheduling management interviews, tracking and managing data. - Communicate and promote internal staffing objectives, such as referrals and internal employment opportunities. - Electronic filing of documents, updating and maintaining information in the HRIS and ensuring employment documents are uploaded to employee records. - Onboard new clients and ensure adherence with I9 requirements, acknowledgement of guides & policies, and signed employment paperwork. - Assist with scheduling new employees for orientation, training, benefits, and performance reviews. - Direct and answer employee questions regarding onboarding, benefits and directing employees to appropriate Human Resource staff when necessary. - Work with managers to submit employee action forms for changes to salaries/commissions/bonuses/stipends. - Work with managers and supervisors regarding all aspects of employee management. - Designs and develops training programs that align with the company’s strategic goals and employee development needs. Qualifications - An Associate’s Degree or Bachelor’s Degree is preferred. - SHRM or HRCI certification is preferred. - Business experience in a healthcare and/or insurance setting is preferred. Requirements - Exceptional communication skills with a clear understanding of company business lines. - Ability to apply critical thinking, manage time efficiently and meet specific deadlines. - Computer literacy and typing skills are essential. Benefits - Medical, dental, and vision coverage for you and your family. - Voluntary life insurance options for you, your spouse, and your children. - Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans. - Basic life insurance, short-term disability, and 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.

Role Description Calling all bill review professionals, CPC coders, AAPC, and DRG coders! Dane Street is looking for highly motivated Coders, bill reviewers, and payment integrity reviewers candidates to join our team. Dane Street offers an exciting work environment, competitive compensation, and strong growth potential. 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 determines whether they meet all established program standards. - Ensures that the medical records are matched appropriately to the codes and if not, obtains them. - Reads & applies policy guidelines and healthcare terminology and delineates 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. Qualifications - Must have a CPC, APCC, CMBS, 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. Requirements - 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. Benefits - Robust opportunity for supplemental income. - Schedule flexibility and predictable work hours - conduct reviews based on your schedule availability. - Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal.

Role Description As an Expert Witness for Dane Street, you will apply your deep industry knowledge of Federal Motor Carrier Safety Regulations (FMCSR) and trucking best practices to evaluate the merits of legal claims. You will act as a neutral third-party expert, providing objective analysis through written reports and, when necessary, oral testimony. - Comprehensive File Review: Analyze driver qualification files, Hours of Service (HOS) logs, electronic logging device (ELD) data, maintenance records, and company safety policies. - Accident Analysis: Review police reports, scene photos, and telematics data to assess compliance or deviations from industry standards at the time of an incident. - Expert Reporting: Author clear, well-supported, and objective expert reports that detail your findings and professional opinions. - Litigation Support: Provide credible deposition and/or trial testimony to explain technical findings to a judge or jury. Qualifications - Industry Expertise: Extensive background in trucking safety management, DOT compliance, or fleet operations. - Testimony Experience: Required. Candidates must have prior experience providing sworn testimony in depositions or trial settings as a disclosed expert. - Regulatory Mastery: Expert-level knowledge of FMCSR, CDL requirements, and industry "standard of care" for motor carriers. - Technical Skills: Superior analytical abilities with the skill to translate complex regulations into layman's terms. - Communication: Exceptional writing skills and the ability to meet strict legal deadlines. Benefits - Ultimate Flexibility: This is a case-by-case 1099 position. You have full autonomy to accept or decline assignments based on your current schedule and expertise. - Competitive Compensation: We offer attractive hourly or flat-rate fees for review time and testimony. - Full Administrative Support: Dane Street handles all intake, records organization, and delivery. We provide all case materials via our secure platform so you can focus on the analysis. - Efficient Workflow: Standard report turnaround time is typically 5 business days from receipt of all materials. - Join the Dane Street Panel: If you are a seasoned trucking professional with the litigation experience necessary to provide high-level expert analysis, we invite you to apply. Help us bring clarity and compliance expertise to the forefront of transportation reviews. - Flexible, remote consulting opportunities - Access to a steady pipeline of cases - Administrative and case management support - Work with a respected leader in independent review services

Role Description Dane Street wants you to join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct thorough reviews of clinical cases. This telework opportunity allows you to customize your schedule as a 1099 independent contractor. - Evaluate medical records - Provide clinical summaries - Engage in peer communications - Answer specific questions posed by our clients We are on the lookout for talented professionals in the following area: - Dermatology Be a part of a team that values your skills and dedication to improving patient care. Your expertise is vital to helping us deliver high-quality healthcare assessments. Qualifications - Board Certified in Dermatology - Current, unrestricted D.C., MD or VA Medical License - 5+ years of clinical practice experience Requirements - Attends all required orientation and training - Maintains proper credentialing, state licenses, and any certifications or requirements necessary to perform the job Benefits - Independent consultant role allows for schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct this work based on your scheduled availability - No doctor/patient relationship is established, and no treatment is provided; these are advisory-only opinions - Dane Street offers a streamlined case flow and a user-friendly work portal - We facilitate all communication, organize and sort all medical records, support all administrative processes, prep cases extensively, and ensure the quality and timely delivery of all determinations/reports - A chronological listing of medical records as well as all treatment guidelines used to make a determination are provided in an easy, click-to-view format - Dane Street offers initial training as well as an ongoing point of contact should you have any questions about completing reviews