Role Description Dane Street is an Independent Review Organization and a national provider of Utilization Review services. We are expanding our physician panel, resulting in opportunities for non-traditional physician work and supplemental income. This is a telework opportunity for physicians providing a caseload customized to your schedule. - Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case basis. - We are looking for the following specialties with an active Tennessee License: - Neurological Surgery - The average time spent on most reviews is 15-20 minutes, allowing for several cases to be completed within an hour. - Training and onboarding can be completed in less than 1 week, and you can start earning compensation for reviews while maintaining your active practice. - No doctor/patient relationship is established, and no treatment is provided; these are advisory-only opinions. - Typical turnaround time (TAT) is 1-5 business days depending on the level of review; same-day cases are rare but do occur. - Dane Street keeps you apprised of required turnaround times and carefully coordinates all administrative tasks, allowing your time to be spent on clinical decision-making. - Dane Street offers a streamlined case flow and a user-friendly work portal, facilitating all communication and organizing medical records. - A chronological listing of medical records and all treatment guidelines used to make a determination are provided in an easy, click-to-view format. - In cases where peer-to-peer calls are necessary (adverse determinations), Dane Street’s peer coordinators secure provider availability. - Dane Street offers initial training as well as an ongoing point of contact for any questions about completing reviews. Qualifications - Current, unrestricted Tennessee Medical License - Active Practice - Board Certified Requirements - 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.

• Provide clinical review support on a full-time basis to assist with an increase in inventory and client demand • Review medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services • Support timely appeal submissions and inventory management while maintaining quality and compliance standards

Role Description The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Responsible to proactively identify insurance denial trends and to then work with Payer Contracting on these issues. Essential Functions: - Understands and uses various contracts and laws (i.e., ERISA, self-funded, State and Federal insurance) to appropriately appeal medical claims that have been denied. - Conducts and refers patient accounts when requested by payers, audit firms, patient and RCO departments to determine the appropriateness of billed charges, chargemaster data, revenue cycle data and UB/HCFA1500 information that is on the claim. - Interprets and accurately identifies the true reason of the denial and reviews payer contracts, clinical data and other data to be able to appeal in a correct and concise way. - Assesses the appropriateness of clinical appeal requests by working with and using evidence-based utilization review criteria, payer policies and Federal and State regulations. - Refers appeal cases to the designated Physician Advisor and works with them to obtain support for appeals. - Collaborates with Care Management, Physician Advisors, Revenue Integrity, Compliance, legal counsel, and RSC teams to prepare appeals. - Identifies trends and opportunities for denial prevention and collaborates with the appropriate multidisciplinary teams to improve denial management, documentation, and appeals process. - Supports legal counsel to prepare for Administrative Law Judge hearings as part of the appeal process. - Serves as a subject matter expert, resource and mentor to others within the RCO, clinical departments, Appeal RN’s, legal, IPAS and Payor Contracting on the art of appealing. Qualifications - Demonstrated experience in a healthcare revenue cycle role. - Demonstrated proficiency in computer skills including Microsoft Office, internet and email. - Demonstrated experience in a role utilizing exceptional written communication skills. - Demonstrates knowledge of State/Federal/ERISA and self-funded insurance laws. - Preferred: Demonstrated experience in healthcare insurance billing, follow-up, denials and appeals or audit role. - Preferred: Bachelor’s degree. - Preferred: Experience with Epic. Requirements - Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs. - Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately. - Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy, including frequent computer use for typing and accessing needed information. - May have the same physical requirements as those of clinical or patient care jobs, when the leader takes clinical shifts. - For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles. Benefits - Generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Role Description Dane Street is excited to invite Board Certified Physicians to join our Disability Peer Review team! This telework opportunity offers physicians the chance to evaluate and review disability claims—all from the convenience of home. - Independent physician panel consists of contract reviewers (1099) who enjoy flexible scheduling. - Empowering you to balance work with your lifestyle. - No doctor/patient relationship is established and no treatment is provided; these are advisory-only opinions. - Typical TAT is 3-5 business days depending on the level of review. - Dane Street keeps you apprised of required turn-around time and carefully coordinates all administrative tasks so your time is spent on clinical decision-making. - 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. - Dane Street offers initial training as well as an ongoing point of contact should you have any questions about completing reviews. Qualifications - Board Certification - Current, unrestricted medical license - 5+ years of clinical practice experience - Experience in conducting Disability Peer Reviews preferred Requirements - 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. Benefits - Flexible scheduling - Work from home - Support for administrative processes