Medical Bill Review Supervisor (Working Supervisor & Legal Expert)

Summary We are seeking a highly skilled, hands‑on Medical Bill Review (Working) Supervisor to lead our day‑to‑day bill review operations while actively participating in complex case reviews and serving as a key resource for our legal services division. In this dual‑capacity role, you will manage a small team of bill reviewers and maintain a production workload focused on high‑dollar, complex medical bill review/legal cases. You will leverage an intimate knowledge of major medical bill review software and national repricing/payer systems, ensuring absolute accuracy in identifying excessive or unsupported charges, determining reasonable reimbursement amounts, and defending those findings in litigation. Crucially, you will serve as a Subject Matter Expert (SME) and Expert Witness for legal proceedings, providing forensic billing analyses, affidavits, and deposition/trial testimony. This is a national role; however, Texas‑specific expertise is preferred in billing regulations, workers’ compensation guidelines, and Usual, Customary for other states, and Reasonable (UCR) fee structures. Primary Responsibilities Operations & Production Leadership (Working Supervisor) Team Management: Supervise, mentor, and audit the performance of expert bill review staff and contract experts to ensure accuracy, productivity, and adherence to turnaround times. Hands‑on Review: Function as a "working" supervisor by directly reviewing complex, high‑dollar, or disputed medical bills (e.g., trauma, inpatient stays, etc). Quality Assurance: Conduct regular quality control audits on team output, identifying training gaps and updating standard operating procedures (SOPs). Software & Payer System Repricing Optimization System Mastery: Act as the internal administrator/expert for our Medical Bill Review software, optimizing workflows, auto‑adjudication rules, and engine logic specific to Dane Street and Client preferences and requirements. National Repricing/Payer Systems: Apply comprehensive knowledge of national repricing mechanisms and payer guidelines to maximize accuracy and identify erroneous billing/overbilling. Reimbursement Integrity: Ensure correct application of fee schedules, line‑item audits, CCI edits, and clinical validation rules across commercial, auto/PIP, and workers' compensation lines. Legal Services & Expert Witness Support Forensic Auditing: Conduct comprehensive forensic reviews of medical records, itemized bills, and payment ledgers for cases entering litigation. Expert Reports & Affidavits: Author legally defensible, clear, and well‑supported expert reports outlining billing accuracy, unbundling, upcoding, or phantom charges. Testimony: Provide credible, articulate deposition and trial testimony as a designated expert witness, translating complex coding systems (CPT, ICD-10, HCPCS, DRG) into plain language for attorneys, judges, and juries. (PREFERRED) Texas Regulatory Alignment: Demonstrate masterful application of Texas‑specific codes (e.g., Texas Labor Code for Workers' Comp, Texas Civil Practice and Remedies Code Section 18.001 affidavits, and TDI regulations). Required Qualifications & Experience Experience: Minimum of 5–7 years of extensive, hands‑on experience in Medical Bill Review 2+ years of experience in a supervisory, team‑lead, or senior mentoring capacity. Proven, documented experience providing legal services, expert witness reports, or trial testimony regarding medical bill reasonableness and UCR value analysis. Technical Expertise: Advanced proficiency in major industry‑standard bill review platforms (e.g., Conduent/StrataCare, Mitchell/Enlyte, Medata, CompIQ or similar) Based in Texas (highly preferred) or possessing extensive experience testifying specifically within the Texas court system and applying Texas statutory fee schedules. Certifications: Active industry certification is strictly required (e.g., CPC, CCS) Key Competencies The ability to spot subtle patterns of healthcare fraud, waste, and abuse or systemic billing irregularities. Poised, articulate communication style. Highly professional under examination/expert testimony pressure. Strong time‑management skills to effortlessly pivot between managing a team, clearing daily production queues, and meeting deadlines. 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 which include 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 ensures you have time to relax and recharge. 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend provided for remote workspace. ABOUT DANE STREET 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. #J-18808-Ljbffr Dane Street, LLC