Job Summary
The Bill Review Specialist connects our clinical data with strategy. In this role, you will apply specialized expertise in medical data entry, and national repricing systems to analyze complex, high-exposure medical claims and litigation demands. By conducting precise line-item audits, you uncover billing irregularities and deliver clear, defensible insights that attorneys and adjusters rely on to make fair, evidence-based decisions. Your work directly safeguards reimbursement integrity and upholds Dane Street’s reputation for excellence in the legal and healthcare communities.
Mission, Culture and 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
Conduct regular quality control of reports
Software & Payer System Repricing Optimization
Apply knowledge of repricing payer guidelines to maximize accuracy and identify erroneous billing/overbilling.
Ensure correct application of fee schedules, line-item audits,CCI edits, and clinical validation rules across commercial, auto/PIP, and workers' compensation lines.
Translating complex coding systems (CPT, ICD-10, HCPCS, DRG) into plain language for attorneys.
What Makes this Role Successful
The Bill Review Specialist role combines analytical precision with a sharp eye for clinical coding and reimbursement integrity. You thrive in the details, moving effortlessly between line-item audits and national repricing platforms to spot billing anomalies, unbundling, and fee schedule discrepancies. By consistently applying NCCI edits and clinical validation rules, you ensure every report produced is audit-proof, accurate, and aligned with current payer guidelines. You can also successfully translate dense coding structures into straightforward, plain-language insights that attorneys and adjusters can confidently stand behind during litigation and settlement negotiations.
What Your First 90 Days May Look Like
First 30 days
Become familiar with Dane Street's Medical Bill Review processes, systems, and workflows.
Learn national repricing systems, payer guidelines, and client-specific requirements.
Understand fee schedules, UCR benchmarks, NCCI edits, and coding guidelines.
Review sample medical bills and reports to understand quality and accuracy expectations.
Become familiar with CPT, ICD-10, HCPCS, and DRG coding.
First 31-60 days
Independently review and audit medical bills and supporting documentation.
Identify duplicate, excessive, unsupported, unbundled, or incorrectly billed charges.
Apply appropriate fee schedules, repricing guidelines, and coding edits.
Prepare accurate and detailed bill review reports.
Meet established productivity, quality, and turnaround time expectations.
Communicate billing discrepancies and findings clearly to the appropriate teams.
First 61-90 days
Consistently manage assigned bill review workload with accuracy and efficiency.
Demonstrate proficiency in repricing systems and medical billing guidelines.
Produce accurate, complete, and defensible reports.
Independently identify billing irregularities and reimbursement discrepancies.
Translate complex billing and coding information into clear, understandable findings.
Identify opportunities to improve review accuracy, workflow efficiency, and overall quality.
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 of sitting or remaining stationary at a desk and working on a computer.
Constant…