Medical Reimbursement Coding Specialist

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🏥 Medical Billing and Coding

👻 Ghost score 25%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 47 days.
• 189 open roles for a team of 248.
• No salary listed.

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Dane Street

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

📋 Description

• Review complex, high-dollar, or disputed medical bills, including trauma and inpatient stays • Conduct regular quality control of reports • Administer and optimize Medical Bill Review software, workflows, auto-adjudication rules, and engine logic • Apply knowledge of national repricing mechanisms and payer guidelines • Ensure correct application of fee schedules, line-item audits, CCI edits, and clinical validation rules across commercial, auto/PIP, and workers’ compensation lines • Conduct forensic reviews of medical records, itemized bills, and payment ledgers for litigation cases • Author legally defensible expert reports regarding billing accuracy, unbundling, upcoding, and phantom charges • Translate CPT, ICD-10, HCPCS, and DRG coding systems into plain language for attorneys • Serve as a Subject Matter Expert and Expert Witness for legal proceedings • Provide forensic billing analyses, affidavits, deposition testimony, and trial testimony • Support attorneys and Legal Services with billing questions and case documentation • Identify excessive, unsupported, duplicate, or improperly billed charges • Determine reasonable reimbursement amounts and defend findings in litigation • Identify opportunities to improve software functionality, workflows, accuracy, efficiency, and quality standards • Manage a consistent production workload of complex medical bill reviews

🎯 Requirements

• Active industry certification is strictly required (e.g., CPC, CCS) • Experience with Fee schedule UCRs / Benchmark surveys • Strong critical thinking and independent case assessment • Ability to interpret complex instructions, recognize risks, and determine appropriate escalation • Excellent organization, prioritization, time management, and follow-through across high-volume, deadline-driven work • Working knowledge of clinical and legal review workflows, expert credentials, report quality expectations, and company service lines • Ability to coordinate across clients, physicians, attorneys, adjusters, Sales, Operations, Management, and Finance • Computer literacy and typing proficiency • Extensive, hands-on experience in Medical Bill Review • Proven, documented experience providing legal services, expert witness reports, or trial testimony regarding medical bill reasonableness and UCR value analysis • Advanced proficiency in major industry-standard bill review platforms (e.g., Conduent/StrataCare, Mitchell/Enlyte, Medata, CompIQ or similar) • Based in Texas is highly preferred, or extensive experience testifying specifically within the Texas court system and applying Texas statutory fee schedules • Ability to spot subtle patterns of healthcare fraud, waste, and abuse or systemic billing irregularities is preferred • Poised, articulate communication style and professionalism under examination/expert testimony pressure are preferred • 2–4+ years of experience in customer service, account management, customer success, insurance operations, healthcare operations, or another client-facing operational environment • Business experience in a healthcare and/or insurance setting is preferred • Strong communication skills, professional judgment, discretion, relationship-building, and conflict-resolution skills • Ability to learn and maintain accurate records in company systems • Supply and support own internet services • Maintaining an uninterrupted internet connection is required for the work-from-home position

🏖️ Benefits

• Medical, dental, and vision coverage for employees and families • Voluntary life insurance for employees, spouses, and children • Hospital indemnity, critical illness, accident indemnity, and pet insurance plans • Basic life insurance at no cost • Short-term disability coverage at no cost • Long-term disability coverage at no cost • Generous paid time off • 401(k) plan with company match • Apple equipment for remote workspace • Media stipend for remote workspace • Collaborative remote culture • Professional growth opportunities • Comprehensive benefits • Commitment to employee development

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