Medical Bill Review Supervisor (Working Supervisor & Legal Expert)

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.

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.

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.