Medical Bill Review Supervisor (Working Supervisor & Legal Expert)

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.

• 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).

• 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.

• 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).

• 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)

• 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.

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind.

We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans.

Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

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.