Medical Bill Review Supervisor (Working Supervisor & Legal Expert)

Dane Street, LLC

4d•Remote

About The Position

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

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.
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.
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.

Nice To Haves

Texas-specific expertise in billing regulations, workers' compensation guidelines, and Usual, Customary for other states, and Reasonable (UCR) fee structures.

Responsibilities

Supervise, mentor, and audit the performance of expert bill review staff and contract experts to ensure accuracy, productivity, and adherence to turnaround times.
Directly review complex, high-dollar, or disputed medical bills (e.g., trauma, inpatient stays, etc).
Conduct regular quality control audits on team output, identifying training gaps and updating standard operating procedures (SOPs).
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.
Apply comprehensive knowledge of national repricing mechanisms and payer guidelines to maximize accuracy and identify erroneous billing/overbilling.
Ensure correct application of fee schedules, line-item audits, CCI edits, and clinical validation rules across commercial, auto/PIP, and workers' compensation lines.
Conduct comprehensive forensic reviews of medical records, itemized bills, and payment ledgers for cases entering litigation.
Author legally defensible, clear, and well-supported expert reports outlining billing accuracy, unbundling, upcoding, or phantom charges.
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.
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).