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.

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....

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.

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.

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....

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.