Medical Bill Review Consultant

Medical Equation•Austin, TX

About The Position

The Medical Bill Review Expert Witness provides independent, objective, well-supported opinions concerning medical billing, healthcare reimbursement, adjustments, coding, billed charges, and the reasonable value or market value of healthcare goods and services. The position reviews medical bills, future cost estimates and life care plans, clinical records, payment information, billing affidavits, invoices, HCFA 1500 forms, provider statements, and reimbursement data. The expert assesses documentation and coding accuracy and evaluates charges against applicable payment methodologies and publicly available market information and benchmarks. The role prepares clear, defensible expert reports, affidavits, declarations, rebuttal and supplemental analyses, exhibits, schedules, demonstrative analyses, and other litigation-support materials. The expert may testify at depositions, hearings, arbitrations, or trials and must explain complex medical billing and reimbursement concepts to non-technical audiences. The expert is expected to maintain professional independence, use reliable and explainable methods, meet litigation deadlines, protect confidential and protected health information, disclose conflicts, and testify only within areas supported by their qualifications. The position primarily operates in a professional office or remote-office environment and involves extended review of records, data analysis, report preparation, meetings, and testimony. Travel of up to 10 percent may be required for case-related activities. Medical Equation is an equal opportunity employer.

Requirements

Bachelor’s degree in healthcare administration, healthcare finance, accounting, business administration, economics, nursing, health information management, or a related field; an equivalent combination of relevant education, professional credentials, and substantial healthcare reimbursement experience may be considered.
Substantial professional experience in medical bill review, healthcare reimbursement, medical coding or auditing, revenue cycle management, healthcare finance, claims administration, healthcare compliance, payment analysis, or healthcare consulting.
Demonstrated experience reviewing medical bills and related clinical or financial documentation, conducting comparative charge, payment, adjustment, or reimbursement analyses, and preparing written reports explaining healthcare financial findings.
Working knowledge of healthcare claims processing, reimbursement methodologies, CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, billing conventions, and payment models across multiple healthcare settings, including self-pay and private-pay arrangements.
Ability to organize and analyze large volumes of billing, clinical, reimbursement, and payment information.
Ability to explain healthcare charge valuation clearly to non-technical audiences.
Appropriate knowledge, skill, experience, training, or education for the particular opinions offered.
Advanced knowledge of medical billing, coding, claims processing, healthcare reimbursement, and the AMA’s adoption of RVRBS.
Knowledge of healthcare charge structures, payment mechanisms, contractual adjustments, and reimbursement benchmarks.
Ability to select, apply, and explain reliable medical-charge valuation methods and assess the relevance, reliability, strengths, and limitations of healthcare financial data.
Ability to distinguish charges, payments, allowed amounts, contractual rates, adjustments, write-offs, and outstanding balances.
Strong quantitative, analytical, research, problem-solving, written communication, technical report-writing, verbal communication, and presentation skills.
Ability to respond professionally and accurately during questioning or cross-examination and remain objective and independent regardless of the retaining party.
Ability to identify and disclose assumptions, limitations, missing information, and alternative interpretations.
Excellent attention to detail and commitment to accuracy; ability to verify data, calculations, citations, schedules, and records.
Effective organization, deadline management, and case-file management skills.
Proficiency with standard office, spreadsheet, document-management, and analytical software.
Ability to handle confidential information with discretion and protect case, medical, client, and attorney work-product information.
Sound judgment, credibility, research proficiency, adaptability, and professional independence.
Ability to communicate and testify within the limits of one’s expertise and explain methods and opinions clearly and consistently.

Nice To Haves

Prior experience serving as a medical bill review expert witness or consulting expert, including preparing reports, affidavits, declarations, or rebuttal analyses and providing deposition, hearing, arbitration, or trial testimony.
Experience evaluating billing charges, UCR, past medical expenses, future medical costs, surgical cost estimates, or life care plan cost estimates.
Familiarity with Texas healthcare billing and reimbursement matters and litigation involving the reasonableness of medical charges.
Experience supporting attorneys in personal injury, insurance, workers’ compensation, healthcare, or other medical-expense disputes.
Advanced degree or additional professional education in healthcare finance, coding, auditing, economics, accounting, or a related discipline.

Responsibilities

Review itemized medical bills, claim forms, clinical records, explanation of benefits documents, payment records, contractual information, and other case materials.
Determine whether billed services are supported by the clinical and billing documentation.
Evaluate procedure and supply codes, revenue codes, modifiers, units, dates of service, and other billing information for accuracy and consistency.
Identify duplicate, unsupported, anomalous, inconsistent, or unbundled charges and other issues affecting medical-expense evaluation.
Reconcile billing records with payments, adjustments, write-offs, balances, and other financial documentation.
Review relevant coding standards and information, including AMA CPT, HCPCS, ICD-10-CM, and revenue codes.
Analyze charges using appropriate reimbursement methodologies and benchmarks across relevant healthcare service categories.
Evaluate future medical cost projections, surgical cost estimates, and life care plan amounts when within the engagement scope.
Develop reasonable-value opinions using methods appropriate to the services, providers, geography, dates, and available case information.
Distinguish billed charges from payments, allowances, contractual adjustments, discounts, and other financial measures.
Document assumptions, limitations, exclusions, unavailable information, source materials, work performed, methodologies, calculations, findings, opinions, and reports in an organized and reproducible manner.
Prepare expert reports, affidavits, declarations, rebuttal analyses, supplemental reports, exhibits, schedules, and demonstrative analyses.
Explain technical findings and the basis for opinions in clear language for attorneys, judges, juries, and other non-technical audiences.
Review opposing expert materials and identify material differences in data, assumptions, methodologies, calculations, and conclusions.
Assist retaining counsel with medical billing, reimbursement, coding, and healthcare valuation issues within the engagement scope.
Respond accurately and professionally to questions about opinions, methods, sources, calculations, and supporting documentation.
Meet court, discovery, report, and other deadlines communicated by retaining counsel.
Form and communicate truthful, objective, independent opinions based on available evidence and reliable methods, including evidence that may not support the retaining party.
Testify only within areas supported by the expert’s knowledge, education, training, skill, and experience, and maintain consistency across analysis, reports, depositions, and trial testimony.
Correct or disclose material errors or omissions when identified.
Protect confidential case information, attorney work product, personally identifiable information, and PHI in accordance with the HIPAA Privacy Rule.
Avoid conflicts of interest and promptly disclose actual or potential conflicts.
Maintain professional conduct and comply with company policies, confidentiality requirements, and engagement terms.
Remain current on coding conventions, reimbursement practices, payment methodologies, billing developments, and relevant professional standards.
Maintain applicable credentials and complete required continuing education.
Participate in quality-control and peer-review processes while preserving independent judgment.
Contribute to report templates, research protocols, valuation procedures, and quality standards.
Perform additional qualified duties and case-related projects as assigned.
Identify qualifications relevant to opinions in Texas matters; explain the relationship of education, training, credentials, and experience to those opinions; identify considered facts and methodology; acknowledge limitations and contrary information; avoid legal or clinical opinions outside qualifications; and cooperate with counsel on disclosure and testimony requirements while preserving independence.