Medical Reimbursement Coding Specialist (Texas)

JOB SUMMARY

We are seeking a highly skilled, hands-on Medical Reimbursement coding specialist to join 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. You will 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.

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

Main Duties:

• Hands-on Review: Directly review complex, high-dollar, or disputed medical bills (e.g., trauma, inpatient stays, etc).
• Quality Assurance: Conduct regular quality control of reports
• 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.
• Forensic Auditing: 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.
• Translating complex coding systems (CPT, ICD-10, HCPCS, DRG) into plain language for attorneys.
• (PREFERRED) Texas Regulatory Alignment: Demonstrate masterful application of Texas-specific codes/Texas Civil Practice and Remedies Code Section 18.001 affidavits, and TDI regulations).

What Makes This Role Successful: Business experience in a healthcare and/or insurance setting is preferred. Good communication skills with a clear understanding of company business lines. The ability to apply critical thinking, manage time efficiently, and meet specific deadlines. Computer literacy and typing skills are essential. 2-4+ years of experience in customer service, account management, customer success, insurance operations, healthcare operations, or another client-facing operational environment. Present exceptional communication skills with a clear understanding of company business lines.

What Your First 90 Days May Look Like:

First 30 days

• Become familiar with Dane Street's Medical Bill Review and Legal Services processes.
• Learn the company's bill review software, repricing systems, fee schedules, and client-specific requirements.
• Review complex medical bills, including high-dollar and disputed cases.
• Understand documentation, quality standards, and legal reporting expectations.
• Become familiar with expert witness responsibilities, affidavits, and testimony requirements.
• Identify opportunities to improve accuracy and efficiency in bill reviews.

First 31-60 days

• Independently review complex, high-dollar medical bills and disputed cases.
• Apply appropriate fee schedules, UCR benchmarks, coding guidelines, and payer rules.
• Conduct quality reviews to ensure accuracy and defensibility of findings.
• Prepare detailed billing analyses and legally supported expert reports.
• Identify excessive, unsupported, duplicate, or improperly billed charges.
• Support attorneys and Legal Services with billing questions and case documentation.
• Demonstrate proficiency in bill review software and repricing systems.

First 61-90 days…

• Manage a consistent production workload of complex medical bill reviews.
• Demonstrate accuracy and efficiency in identifying billing discrepancies and appropriate reimbursement amounts.
• Independently prepare and defend expert billing analyses and reports.
• Serve as a subject matter expert for Medical Bill Review and Legal Services.
• Support deposition and trial preparation, including expert testimony as required.
• Identify opportunities to improve software functionality, workflows, and quality standards.
• Demonstrate strong knowledge of applicable national and Texas-specific billing guidelines and regulations.