医疗账单评审主管（工作主管及法律专家）
Medical Bill Review Supervisor (Working Supervisor & Legal Expert)
简介
我们正在寻找一位技术娴熟、亲力亲为的医疗账单审核（工作）主管，负责领导我们的日常账单审核运营工作，同时积极参与复杂案件的审核，并作为法律服务部门的关键资源。在这个双重职责的角色中，您将管理一个小的账单审核团队，并专注于高金额、复杂的医疗账单审核/法律案件的生产性工作。您将利用对主要医疗账单审核软件和国家重新定价/支付方系统的深入了解，确保准确识别过度或无依据的费用，确定合理的报销金额，并在诉讼中捍卫这些发现。至关重要的是，您将作为主题专家（SME）和专家证人参与法律程序，提供法医账单分析、宣誓书以及质询/审判证词。这是一个全国性的职位；然而，优先考虑在医疗账单法规、工伤赔偿指南以及各州通常、常用和其他合理（UCR）费用结构方面具备德克萨斯州专业知识的人选。
要求
主要职责
运营与生产领导（工作主管）
- 团队管理：监督、指导并审核专家账单审核人员及合同专家的工作表现，确保准确性、生产力和按时完成。
- 亲自审核：作为“工作”主管，直接审核复杂、高金额或有争议的医疗账单（例如创伤、住院等）。
- 质量保证：定期对团队产出进行质量控制审计，识别培训差距并更新标准操作流程（SOP）。
- 软件与支付方系统重新定价优化
- 系统精通：作为我们医疗账单审核软件的内部管理员/专家，优化工作流程、自动裁决规则和引擎逻辑，具体针对Dane Street和客户偏好及需求。
- 国家重新定价/支付方系统：运用对国家重新定价机制和支付方指南的全面知识，提高准确性并识别错误计费/超额计费。
- 报销完整性：确保费用表的正确应用、逐项审计、CCI编辑和临床验证规则在商业、汽车/PIP和工伤赔偿业务中的正确执行。
- 法律服务与专家证人支持
- 法医审计：对医疗记录、明细账单和付款记录进行全面法医审查，
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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)
Key Competencies
- 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.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
Originally posted on Himalayas