Medical Bill Review Consultant

Medical Equation, Inc.•Austin, TX

About The Position

The Medical Bill Review Expert Witness provides independent, objective, and 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 role reviews medical bills, future cost estimates and life care plans, clinical records, payment information, billing affidavits, invoices, claim forms, provider statements, and relevant reimbursement data to determine whether charges are documented, accurately coded, and reasonable under applicable payment methodologies and market benchmarks. The expert prepares reports, affidavits, declarations, demonstrative analyses, and other litigation-support materials, and may testify in depositions, hearings, arbitrations, or trials. The position requires explaining complex billing and reimbursement concepts clearly to technical and non-technical audiences while maintaining objective, independent professional judgment. The role primarily operates in a professional office or remote-office environment and involves extended periods of reviewing records, analyzing data, preparing reports, and participating in meetings or testimony. Travel of up to 10 percent may be required for case-related activities.

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, common reimbursement methodologies, CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, billing conventions, and payment models across multiple healthcare service 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 the valuation of healthcare charges clearly to non-technical audiences.
Advanced knowledge of medical billing, coding, claims processing, and healthcare reimbursement, including 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.
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.
Ability to remain objective and independent, identify assumptions and limitations, and disclose missing information and alternative interpretations.
Excellent attention to detail, accuracy, organization, deadline management, and case-file management.
Proficiency with standard office, spreadsheet, document-management, and analytical software.
Ability to handle confidential information with discretion and demonstrate sound judgment, credibility, adaptability, time management, research proficiency, and professional independence.
Appropriate knowledge, skill, experience, training, or education for the particular opinions offered.
Ability to identify qualified subject areas and explain how education, training, credentials, and experience relate to opinions.
Ability to identify the facts, records, data, and assumptions considered; explain and apply the methodology for each material opinion; acknowledge limitations, missing records, and contrary information; and avoid legal conclusions or clinical opinions outside the expert’s qualifications.
Ability to cooperate with retaining counsel on applicable disclosure, report, affidavit, and testimony requirements while preserving professional independence.

Nice To Haves

Prior experience serving as a medical bill review expert witness or consulting expert, including preparing expert 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, medical 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 the accuracy and consistency of procedure codes, supply codes, revenue codes, modifiers, units, dates of service, and other billing information.
Identify duplicate or unsupported charges, coding inconsistencies, unbundling, billing anomalies, and other issues affecting medical-expense evaluations.
Reconcile billing records with payments, adjustments, write-offs, balances, and other financial documentation.
Review relevant coding standards and analyze charges using appropriate reimbursement methodologies and information.
Evaluate charges and charge-to-payment or reimbursement benchmarks across healthcare service categories.
Evaluate future medical cost projections, surgical cost estimates, and life care plan amounts when within the engagement scope.
Develop opinions concerning the reasonable value of medical services using case facts, professional expertise, and reliable analytical methods.
Select and apply valuation methods appropriate to the services, providers, geographic area, dates of service, and available information.
Distinguish billed charges from payments, reimbursement allowances, contractual adjustments, self-pay discounts, and other financial measures.
Document assumptions, limitations, exclusions, unavailable information, materials reviewed, work performed, methodologies, calculations, findings, opinions, and reports.
Prepare expert reports and litigation-support materials, including affidavits, declarations, rebuttal analyses, supplemental reports, exhibits, schedules, and demonstrative analyses.
Explain technical findings clearly to attorneys, judges, juries, and other non-technical audiences.
Review opposing expert reports and identify material differences in data, assumptions, methodologies, calculations, and conclusions.
Assist retaining counsel in understanding medical billing, reimbursement, coding, and healthcare valuation issues within the engagement scope.
Respond accurately and professionally to questions about opinions, methodologies, data 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 protected health information 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 professional 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 duties and case-related projects consistent with the expert’s qualifications and professional responsibilities.