Job Summary

The Medical Bill Review Supervisor is a hands-on leadership role responsible for overseeing day-to-day medical bill review operations while maintaining an active production workload focused on complex, high-dollar, and disputed medical bill review cases. This position supervises and develops a team of medical bill reviewers, ensuring accuracy, productivity, quality, and adherence to established turnaround times and client requirements.

The Supervisor serves as a subject matter expert in medical bill review, reimbursement methodologies, national repricing systems, payer guidelines, and applicable fee schedules. This role requires advanced knowledge of medical billing and coding, including CPT, ICD-10, HCPCS, DRG, CCI edits, and clinical validation practices. The Supervisor will also serve as an internal resource for medical bill review software, helping optimize system workflows, auto-adjudication rules, and reimbursement logic based on Dane Street and client-specific requirements.

In addition to operational leadership and production responsibilities, this position plays a critical role in supporting Dane Street's Legal Services division. The Supervisor will conduct forensic medical billing reviews, analyze itemized bills and payment records, prepare legally defensible expert reports and affidavits, and provide deposition and trial testimony when required. This role requires the ability to explain complex medical billing and reimbursement methodologies clearly and professionally to attorneys, judges, and other legal stakeholders.

This is a national role, with a strong preference for Texas-specific expertise in medical billing regulations, workers' compensation fee guidelines, Texas statutory requirements, and Usual, Customary, and Reasonable (UCR) reimbursement methodologies. Success requires strong technical expertise, leadership, independent judgment, attention to detail, and the ability to balance team management, hands-on production, and legal support responsibilities.

Mission, Culture & Values

At Dane Street, we believe exceptional employee experiences create exceptional client experiences. Our culture is built on collaboration, continuous improvement, accountability, and care.

We care for our customers, we care for our employees, and we care for one another. Every team member plays an important role in creating an environment where people feel respected, supported, empowered to grow, and inspired to do meaningful work.

What You'll Do

Medical Bill Review Operations & Production Leadership

• Supervise, mentor, and develop a team of medical bill reviewers and contract experts, ensuring accuracy, productivity, quality, and adherence to established turnaround times.
• Function as a working supervisor by maintaining an active production workload and directly reviewing complex, high-dollar, disputed, and specialty medical bills, including trauma, inpatient hospital stays, and other high-value claims.
• Monitor daily production queues, workloads, performance metrics, and service-level expectations to ensure operational goals are consistently achieved.
• Conduct regular quality assurance audits of team output, identify performance and training gaps, and implement corrective actions and process improvements.
• Establish and maintain standard operating procedures (SOPs), review guidelines, and quality standards to support consistency and accuracy across the department.
• Provide technical guidance and serve as an escalation resource for complex billing, coding, and reimbursement questions.

Medical Bill Review Software & Repricing System Optimization

• Serve as the internal subject matter expert and primary resource for Dane Street's medical bill review software and related repricing systems.
• Optimize system workflows, auto-adjudication rules, reimbursement logic, and review configurations to align with Dane Street's operational requirements and client-specific preferences.
• Maintain advanced knowledge of national repricing mechanisms, payer systems, and reimbursement methodologies.
• Ensure appropriate application of applicable fee schedules, reimbursement guidelines, CCI edits, line-item review standards, and clinical validation rules.
• Identify system inconsistencies, incorrect reimbursement logic, and opportunities to improve automation, accuracy, and operational efficiency.
• Partner with internal technology and operational teams to troubleshoot system issues, implement enhancements, and support evolving client requirements.

Reimbursement Integrity & Technical Expertise

• Ensure accurate review and identification of excessive, unsupported, duplicate, unbundled, or otherwise inappropriate medical charges.
• Evaluate medical bills using applicable reimbursement methodologies, including workers' compensation fee schedules, commercial payer guidelines, auto/PIP reimbursement rules, and UCR methodologies.
• Review complex billing scenarios involving CPT, ICD-10, HCPCS, DRG, modifier usage, coding edits, and clinical documentation.
• Identify potential patterns of healthcare fraud, waste, abuse, upcoding, unbundling, and systemic billing irregularities.
• Establish defensible reimbursement recommendations supported by applicable fee schedules, billing guidelines, documentation, and industry standards.
• Provide technical expertise and guidance to reviewers on complex reimbursement determinations and disputed charges.

Legal Services & Expert Witness Support

• Serve as a key subject matter expert and resource for Dane Street's Legal Services division on complex medical billing and reimbursement matters.
• Conduct comprehensive forensic reviews of medical records, itemized medical bills, billing statements, and payment ledgers for cases involving litigation.
• Prepare clear, accurate, and legally defensible expert reports, affidavits, and supporting documentation addressing billing accuracy, reimbursement reasonableness, UCR values, unbundling, upcoding, and unsupported charges.
• Provide deposition and trial testimony as a designated medical billing expert when required.
• Translate complex medical billing, coding, and reimbursement methodologies into understandable explanations for attorneys, judges, juries, and other legal stakeholders.
• Support legal teams with technical analysis, documentation, and expert opinions regarding medical bill reasonableness and appropriate reimbursement.
• Maintain professional credibility, objectivity, and composure when presenting expert findings during depositions, hearings, and trial proceedings.

Regulatory Compliance & Jurisdictional Expertise

• Maintain working knowledge of applicable national medical billing regulations, reimbursement standards, workers' compensation guidelines, and payer requirements.
• Apply appropriate state-specific fee schedules and reimbursement methodologies across applicable jurisdictions.
• Demonstrate advanced knowledge of Texas-specific workers' compensation billing regulations, statutory fee guidelines, and applicable Texas Department of Insurance requirements.
• Maintain familiarity with Texas Labor Code provisions and Texas Civil Practice and Remedies Code Section 18.001 requirements as they relate to medical billing affidavits and litigation support.
• Monitor regulatory and reimbursement changes and communicate relevant updates to reviewers, leadership, and Legal Services.
• Ensure review practices and expert findings are supported by applicable regulations, documentation, and defensible reimbursement methodologies.

Cross-Functional Collaboration & Continuous Improvement

• Partner with Operations leadership, Legal Services, Sales, and other internal departments to support complex client needs and business objectives.
• Provide technical guidance and training to medical bill reviewers, contract experts, and internal stakeholders.
• Identify opportunities to improve review accuracy, productivity, system performance, and client satisfaction.
• Support the development and implementation of updated review procedures, training materials, and quality assurance standards.
• Balance supervisory responsibilities, daily production requirements, legal requests, and urgent client deliverables while maintaining operational accountability.

What Makes This Role Successful: Success in this role is defined by the ability to balance hands-on medical bill review production with effective team leadership, technical expertise, and legal services support. The successful Supervisor demonstrates advanced knowledge of medical billing, coding, reimbursement methodologies, and national repricing systems while consistently identifying excessive, unsupported, and inappropriate medical charges.

You excel by developing a high-performing team, maintaining quality and productivity standards, and serving as the primary technical resource for complex medical bill review determinations. You proactively identify opportunities to improve software functionality, reimbursement accuracy, and operational workflows while ensuring consistent application of client-specific requirements and applicable fee schedules.

In addition, success requires the ability to conduct defensible forensic billing analyses, prepare expert documentation, and confidently support depositions and trial proceedings. The ideal candidate demonstrates strong professional judgment, credibility, and communication skills while balancing daily production, supervisory responsibilities, legal deadlines, and evolving business needs.

Ultimately, success means delivering accurate and defensible reimbursement recommendations, developing reviewer expertise, strengthening Legal Services support, and driving operational excellence across Dane Street's national medical bill review operations.

What Your First 90 Days May Look Like: 

First 30 days

• Learn Dane Street's medical bill review operations, workflows, software platforms, and client-specific requirements.
• Review existing medical bill review procedures, quality standards, reimbursement methodologies, and production expectations.
• Understand team structure, reviewer responsibilities, performance metrics, and current production workflows.
• Evaluate current repricing systems, auto-adjudication rules, and software configurations.
• Review Legal Services processes and expectations for forensic billing reviews, expert reports, affidavits, and testimony.
• Identify opportunities to improve review accuracy, productivity, and operational efficiency.

First 31-60 days

• Begin independently overseeing daily medical bill review operations and team performance.
• Maintain an active production workload focused on complex, high-dollar, and disputed medical bills.
• Conduct quality assurance audits and provide technical guidance, coaching, and performance feedback to reviewers.
• Evaluate software workflows, reimbursement logic, and repricing configurations for accuracy and efficiency.
• Support complex legal billing reviews and coordinate with Legal Services on expert documentation and case requirements.
• Identify opportunities to improve turnaround times, quality, and consistency across review operations.

First 61-90 days

• Demonstrate full ownership of day-to-day medical bill review operations and team performance.
• Independently manage supervisory responsibilities while maintaining consistent hands-on production.
• Establish and maintain quality assurance standards and reviewer performance expectations.
• Demonstrate advanced proficiency in medical bill review software, national repricing systems, and reimbursement methodologies.
• Provide expert-level support for complex forensic billing reviews and Legal Services requests.
• Identify and implement opportunities to improve system functionality, reimbursement accuracy, and operational workflows.
• Present recommendations to leadership for continued development of the medical bill review department and Legal Services support.

Requirements

EDUCATION/CREDENTIALS:

• Active industry certification is required, such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or an equivalent recognized medical billing and coding certification.
• Relevant education or professional training in medical billing, medical coding, healthcare reimbursement, or a related field.
• Additional certifications or credentials related to medical auditing, healthcare compliance, or reimbursement methodologies preferred.

Must Haves: 

• Minimum of 5–7 years of extensive, hands-on medical bill review experience.
• Minimum of 2 years of supervisory, team-lead, or senior-level mentoring experience.
• Proven experience reviewing complex, high-dollar, disputed, or specialty medical bills.
• Advanced knowledge of medical billing and coding, including CPT, ICD-10, HCPCS, DRG, modifiers, and CCI edits.
• Advanced proficiency with major medical bill review and repricing platforms, such as Conduent/StrataCare, Mitchell/Enlyte, Medata, CompIQ, or comparable systems.
• Strong understanding of national reimbursement methodologies, payer guidelines, workers' compensation fee schedules, commercial reimbursement, auto/PIP, and UCR methodologies.
• Demonstrated ability to identify excessive, unsupported, duplicate, unbundled, or otherwise inappropriate medical charges.
• Proven experience providing legal billing support, forensic medical bill analysis, expert reports, affidavits, or expert witness testimony related to medical bill reasonableness and reimbursement.
• Strong analytical, critical-thinking, and problem-solving skills, with exceptional attention to detail.
• Ability to supervise and develop a team while maintaining an individual production workload.
• Excellent written and verbal communication skills, including the ability to explain complex billing and reimbursement concepts to non-technical audiences.
• Strong time-management and organizational skills, with the ability to balance daily production, team oversight, and time-sensitive legal requests.
• Professional composure and credibility when participating in depositions, litigation support, or expert testimony.

Preferred Qualifications: 

• Texas-based candidate strongly preferred, or extensive experience working with Texas medical billing regulations, workers' compensation fee schedules, and Texas litigation requirements.
• Demonstrated experience applying Texas Labor Code provisions, Texas Department of Insurance regulations, and Texas Civil Practice and Remedies Code Section 18.001 requirements.
• Documented experience providing expert witness testimony, deposition testimony, or litigation support specifically involving medical bill reasonableness and UCR value analysis.
• Advanced knowledge of national payer systems, repricing methodologies, and medical bill review software configuration.
• Experience with inpatient hospital billing, trauma cases, surgical billing, complex specialty services, and high-dollar medical claims.
• Experience identifying healthcare fraud, waste, abuse, coding irregularities, upcoding, unbundling, and unsupported charges.
• Experience developing SOPs, conducting quality assurance audits, training reviewers, and improving medical bill review operations.
• Additional certifications in medical auditing, coding, healthcare compliance, or reimbursement methodologies

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Prolonged periods sitting or remaining stationary at a desk and working on a computer.
• Constant operation of a computer, keyboard, mouse, and other digital productivity tools.
• Close visual acuity required to view computer screens, analyze data, and read extensive digital documentation.
• Frequent communication with team members, leadership, and external partners via email, chat, phone, and video conferencing platforms.
• Occasional moving or positioning of office equipment or files weighing up to 10–15 pounds.

Why Join Dane Street?

• Collaborative remote culture
• Professional growth opportunities
• Meaningful work supporting the healthcare industry
• Comprehensive benefits
• Great Place to Work Certified since 2021
• Commitment to employee development 

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services. 

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Equal Opportunity Statement: 

At Dane Street, caring for people is at the heart of what we do. We are committed to creating an inclusive workplace where every employee feels respected, valued, and empowered to contribute. We provide equal employment opportunities to all applicants and employees and make employment decisions based on qualifications, merit, business needs, and without regard to race, color, religion, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other characteristic protected by applicable federal, state, or local law. 

This job description is subject to change at any time.

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.