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.

Requirements

EDUCATION/CREDENTIALS:

 Active industry certification is strictly required (e.g., CPC, CCS)

Must Haves: 

• Exceptional written and verbal communication, professional judgment, discretion, relationship-building, and conflict-resolution skills. Must have experience in Fee schedule UCRs /Bench Mark 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, typing proficiency, and ability to learn and maintain accurate records in company systems.
• 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.
• 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)

Preferred Qualifications: 

• 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

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Examples:

• 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.