General Coder
About the job
- Active Certified Professional Coder (CPC) certification through the American Academy of Professional Coders (AAPC).
- A minimum of 5–7 years of professional coding experience.
- Documented experience performing audits or utilization reviews in multiple states.
- Strong knowledge of Centers for Medicare & Medicaid Services regulations and state Medicaid variations.
- Experience with Medicare, Medicare Advantage, and commercial payer audits.
- Prior demand package review or litigation support experience.
- Experience reviewing medical records and billing across multiple states and payer environments.
- Ability to review policies and payer rules across multiple jurisdictions and perform multiple types of reviews and audits.
- Perform comprehensive medical coding audits using ICD-10-CM, CPT, and HCPCS.
- Conduct utilization reviews to assess medical necessity and documentation compliance.
- Review the medical portion and prepare the billing and coding review portion of demand package reviews for personal injury and insurance cases.
- Analyze medical records for payer disputes, recoupments, and appeals.
- Prepare detailed, defensible written audit reports.
- Provide expert review, affidavit support, deposition preparation, and testimony when required.
- Interpret Centers for Medicare & Medicaid Services guidelines, Local Coverage Determinations and National Coverage Determinations policies, and state-specific Medicaid and commercial payer rules.
- Review evaluation and management services under 2021 and later guidelines.
- Identify compliance risks and documentation deficiencies.
- Certified Professional Medical Auditor (CPMA) certification is strongly preferred.
- Deposition and/or expert testimony history is preferred.
- Experience responding to Recovery Audit Contractor (RAC), Unified Program Integrity Contractor (UPIC), or commercial payer audits.
- Experience interpreting multi-state Medicaid policies.
- Expert witness experience in civil litigation.
- Data analysis and audit trend reporting.
About the company
Dane Street provides independent medical exams (IMEs) and peer-review services on a nationwide scale. It works with a panel of board-certified physicians located in all 50 states to deliver evaluations across Workers Compensation, Pharmacy, Disability, Group Health, and Auto/Liability cases. The process involves a physician-based review and evaluation system that produces expert reports with faster turnaround times, higher report quality, and increased satisfaction and productivity among adjusters and nurses. The company differentiates itself with its large, nationwide network and its focus on timely, high-quality evaluations across multiple lines of business. Its goal is to improve the accuracy and efficiency of medical reviews to support better decision-making for insurers, employers, and patients.
Company Size
201-500
Company Stage
N/A
Total Funding
N/A
Headquarters
Palm Beach Gardens, Florida
Founded
2008
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Simplify's Take
What believers are saying
- Ted Smith joined September 15, 2026 to scale IME sales across workers' comp and auto.
- March 31, 2026 Quad-C investment funds organic growth and strategic acquisitions.
- 2025 Great Place To Work certification supports recruiting clinicians and retaining operations staff.
What critics are saying
- Insurers and TPAs can internalize utilization review, compressing Dane Street's fee pool by 2027.
- AI-assisted claims platforms can disintermediate IME ordering, threatening core volume and margins.
- If Quad-C overleverages add-on acquisitions, integration failures can erode service quality quickly.
What makes Dane Street unique
- Nationwide IME and peer-review network spans all 50 states and 100 specialties.
- Quad-C backed Dane Street, enabling acquisitions and faster national insurance-market expansion.
- HITRUST AI Assurance and URAC accreditation strengthen trust with regulated payers.
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Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- 401(k) Retirement Plan
- 401(k) Company Match
- Paid Vacation
- Pet Insurance
- Flexible Work Hours