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.
Requirements
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)

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