Bill Review Specialist

Ethos Risk Services•Irving, TX

4d•$17 - $19•Remote

About The Position

Ethos Risk Services is seeking a full-time, U.S.-based remote Bill Review Specialist to review, audit, and process workers’ compensation medical bills. The role ensures compliance with state fee schedules, regulatory requirements, and client-specific guidelines. The ideal candidate is analytical, organized, and committed to accurate, high-quality work in a fast-paced environment. The specialist reviews and adjudicates bills across a range of medical services, researches provider appeals and billing disputes, prepares written reimbursement determinations, and responds to provider inquiries. The role also works with Account Management and other internal stakeholders to address billing issues, answer client questions, and support operational objectives. Candidates must be authorized to work in the United States and must not require current or future employment sponsorship.

Requirements

High school diploma or equivalent.
At least 3 to 5 years of workers’ compensation bill review experience, including reviewing and adjudicating medical bills using state fee schedules, PPO contracts, reimbursement methodologies, client guidelines, and applicable workers’ compensation regulations.
Knowledge of CPT, ICD-10, and HCPCS.
Experience with billing accuracy, reimbursement eligibility, code relationships, bundled services, modifier usage, and reimbursement calculations while applying regulatory and client-specific guidelines.
Authorization to work in the United States without requiring current or future employment sponsorship.

Nice To Haves

Associate’s degree or higher.
Experience using Conduent Strataware or CompIQ software.
Experience applying multi-state workers’ compensation fee schedules, reimbursement methodologies, payment policies, and jurisdiction-specific regulations.
Experience researching complex reimbursement issues, fee schedules, and regulatory guidance to support accurate and defensible payment determinations.
Experience managing provider appeals, reconsiderations, and billing disputes, including communicating reimbursement methodologies and payment decisions.
Experience reviewing complex medical bills, including hospital, ASC, DME, transportation, home health, dental, and other specialty bill types involving advanced reimbursement analysis.

Responsibilities

Review and adjudicate hospital, ambulatory surgery center (ASC), durable medical equipment (DME), pharmacy, transportation, home health, and other specialty medical bills for reimbursement accuracy and compliance.
Investigate provider appeals, reconsiderations, and billing disputes by interpreting applicable fee schedules, reimbursement methodologies, regulations, and client guidelines.
Draft clear, professional written correspondence explaining payment decisions and reimbursement methodologies to providers.
Respond to provider inquiries by phone and in writing regarding reimbursement decisions, payment methodologies, and billing questions.
Partner with the Account Management team and other internal stakeholders to resolve billing issues, answer client questions, and support operational objectives.