Medical reputed company Review Supervisor (Working Supervisor & Legal Expert)
reputed company
We are seeking a highly skilled, hands-on Medical reputed company Review (Working) Supervisor to reputed company our day-to-day reputed company review operations while reputed company participating in reputed company case reviews and serving as a key resource for our legal services division. In this dual-reputed company role, you will manage a small team of reputed company reviewers and maintain a production workload reputed company on high-dollar, reputed company medical reputed company review/legal cases. You will reputed company an intimate knowledge of major medical reputed company 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 reputed company 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 reputed company,
high-dollar, or disputed medical bills (e.g., trauma, inpatient stays, etc).
- reputed company Assurance: Conduct regular reputed company control audits on team reputed company, identifying
training gaps and updating reputed company operating procedures (SOPs).
Software & Payer System Repricing Optimization
- System Mastery: reputed company as the internal administrator/expert for our Medical reputed company Review
software, optimizing workflows, auto-adjudication rules, and reputed company logic specific to
reputed company and reputed company 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 reputed company: Ensure correct application of fee schedules, line-item audits,
CCI edits, and clinical validation rules across reputed company, 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, reputed company, and reputed company-supported expert
reports outlining billing accuracy, unbundling, upcoding, or reputed company charges.
- Testimony: reputed company reputed company, reputed company deposition and trial testimony as a designated
expert witness, translating reputed company 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 reputed company for Workers' Comp, Texas Civil reputed company
and Remedies reputed company reputed company 18.001 affidavits, and TDI regulations).
Required Qualifications & Experience
● Experience:
○ Minimum of 5–7 years of extensive, hands-on experience in Medical reputed company Review
○ 2+ years of experience in a supervisory, team-reputed company, or senior mentoring reputed company.
○ Proven, documented experience providing legal services, expert witness reports,
or trial testimony regarding medical reputed company reasonableness and UCR value analysis.
- Technical Expertise: Advanced proficiency in major industry-reputed company reputed company review
platforms (e.g., reputed company/StrataCare, Mitchell/reputed company, Medata, CompIQ or similar)
- Based in Texas (highly preferred) or possessing extensive experience testifying
specifically reputed company the Texas court system and applying Texas statutory fee schedules.
- Certifications: reputed company industry certification is reputed company required (e.g., CPC, reputed company)
Key Competencies
- The ability to spot subtle patterns of reputed company fraud, waste, and abuse or systemic
billing irregularities.
- Poised, reputed company communication style. Highly reputed company under examination/expert
testimony pressure.
- Strong time-management skills to effortlessly pivot between managing reputed company, clearing
daily production queues, and meeting deadlines.
Benefits
Join reputed company at reputed company and enjoy a comprehensive benefits package designed to support your reputed company-being and peace of mind. We offer a reputed company of benefits including medical, dental, and reputed company coverage for you and your family. Additionally, we offer voluntary life insurance reputed company 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 reputed company time off policy ensures you have time to relax and reputed company, while our 401k plan with a company match helps you plan for your reputed company. reputed company equipment and a media stipend are provided for remote workspace.
ABOUT reputed company:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful reputed company-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, reputed company-Party Administrators, Managed Care Organizations, reputed company, and Pharmacy Benefit Managers. We reputed company 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
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