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About the Role

The Medical Bill Review Expert Witness provides independent, objective, and well-supported opinions concerning medical billing, healthcare reimbursement, adjustments, coding, billed charges, and the reasonable value of healthcare services. This role involves reviewing various medical and financial documents to evaluate charges for accuracy and reasonableness, and preparing clear, defensible reports and potentially providing testimony.

Responsibilities

Review itemized medical bills, claim forms, medical records, explanation of benefits documents, payment records, contractual information, and other case materials.
Determine whether billed services are supported by the documentation contained in the clinical and billing records.
Evaluate the accuracy and consistency of procedure codes, supply codes, revenue codes, modifiers, units, dates of service, and other billing information.
Identify duplicate charges, unsupported charges, coding inconsistencies, unbundling, billing anomalies, and other issues that may affect the evaluation of medical expenses.
Reconcile billing records with payment information, adjustments, write-offs, balances, and other available financial documentation.
Review AMA CPT standards, HCPCS, ICD-10-CM, revenue codes, and other relevant coding information.
Analyze charges using appropriate reimbursement methodologies and information when relevant to the assignment.
Evaluate charges and ratios of charges to applicable payment or reimbursement benchmarks associated with various healthcare service categories.
Evaluate future medical cost projections, surgical cost estimates, and life care plan amounts when included within the scope of the engagement.
Develop opinions concerning the reasonable value of medical services based on the facts of the case, the expert’s education and experience, and reliable analytical methods.
Select and apply valuation methods appropriate to the services, providers, geographic area, dates of service, and available case information.
Clearly distinguish billed charges from payments, reimbursement allowances, contractual adjustments, self-pay discounts, other adjustments, and other healthcare financial measures.
Identify material assumptions, limitations, exclusions, and unavailable information that may affect the analysis.
Maintain organized, reproducible documentation of the materials relied upon, work performed, methodologies used, calculations completed, findings reached, opinions expressed, and reports issued.
Prepare clear, defensible expert reports and related litigation-support materials, including affidavits, declarations, rebuttal analyses, supplemental reports, exhibits, schedules, and demonstrative analyses.
Present technical findings in language that attorneys, judges, juries, and other non-technical audiences can understand.
Review opposing expert reports, analyses, opinions, and supporting materials, and identify material differences in the data, assumptions, methodologies, calculations, and conclusions used in competing analyses.
Assist retaining counsel in understanding medical billing, reimbursement, coding, and healthcare valuation issues within the proper scope of the expert engagement.
Respond accurately and professionally to questions concerning opinions, methodologies, data sources, calculations, and supporting documentation.
Meet court deadlines, discovery deadlines, report deadlines, and other requirements communicated by retaining counsel.
Form and communicate truthful, objective, and professionally independent opinions based on the available evidence and reliable methods.
Testify only within areas supported by the expert’s knowledge, education, training, skill, and experience.
Maintain consistency between the underlying analysis, written report, deposition testimony, and trial testimony.
Make appropriate corrections or disclosures if a material error or omission is identified.
Protect confidential case information, attorney work product, personally identifiable information, and protected health information (PHI) per the HIPAA Privacy Rule.
Avoid conflicts of interest and promptly disclose any actual or potential conflict.
Maintain professional conduct and comply with all applicable company policies, confidentiality requirements, and engagement terms.
Remain current on medical coding conventions, healthcare reimbursement practices, payment methodologies, billing developments, and professional standards.
Maintain applicable professional credentials and complete required continuing education.
Participate in internal quality-control and peer-review processes without compromising the expert’s independent judgment.
Contribute to the development and refinement of report templates, research protocols, valuation procedures, and quality standards.
Perform additional duties and case-related projects as assigned, provided those duties remain consistent with the expert’s qualifications and professional responsibilities.

Requirements

Bachelor’s degree in healthcare administration, healthcare finance, accounting, business administration, economics, nursing, health information management, or a related field.
An equivalent combination of relevant education, professional credentials, and substantial healthcare reimbursement experience may be considered.
Substantial professional experience in medical bill review, healthcare reimbursement, medical coding or auditing, revenue cycle management, healthcare finance, claims administration, healthcare compliance, payment analysis, or healthcare consulting.
Demonstrated professional experience reviewing medical bills and related clinical or financial documentation, conducting comparative charge, payment, adjustment, or reimbursement analyses, and preparing written reports that explain healthcare financial findings.
Working knowledge of healthcare claims processing, common reimbursement methodologies, CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, billing conventions, and payment models across multiple healthcare service settings, including self-pay and private-pay arrangements.
Ability to organize and analyze large volumes of billing, clinical, reimbursement, and payment information.
Ability to explain the valuation of healthcare charges clearly to a non-technical audience.
Prior experience serving as a medical bill review expert witness or consulting expert, including preparing expert reports, affidavits, declarations, or rebuttal analyses and providing deposition, hearing, arbitration, or trial testimony.
Experience evaluating billing charges, UCR, past medical expenses, future medical costs, surgical cost estimates, or life care plan cost estimates.
Familiarity with Texas healthcare billing and reimbursement matters and litigation involving the reasonableness of medical charges.
Experience supporting attorneys in personal injury, insurance, workers’ compensation, healthcare, or other medical-expense disputes.
Advanced degree or additional professional education in healthcare finance, coding, auditing, economics, accounting, or a related discipline.
The expert must have appropriate knowledge, skill, experience, training, or education for the particular opinions to be offered.
Advanced knowledge of medical billing, coding, claims processing, and healthcare reimbursement, including the AMA’s adoption of RVRBS.
Knowledge of healthcare charge structures, payment mechanisms, contractual adjustments, and reimbursement benchmarks.
Ability to select, apply, and explain reliable medical-charge valuation methods.
Ability to distinguish among charges, payments, allowed amounts, contractual rates, adjustments, write-offs, and outstanding balances.
Ability to assess the relevance, reliability, strengths, and limitations of healthcare financial data.
Strong quantitative, analytical, research, problem-solving, written communication, technical report-writing, verbal communication, and presentation skills.
Ability to respond professionally and accurately during questioning or cross-examination.
Ability to remain objective and independent regardless of the identity of the retaining party.
Ability to identify and disclose assumptions, limitations, missing information, and alternative interpretations.
Excellent attention to detail and commitment to accuracy.
Effective organization, deadline management, and case-file management skills.
Proficiency with standard office, spreadsheet, document-management, and analytical software.
Ability to handle confidential information with discretion.
Demonstrates sound judgment, clear written and oral communication, attention to detail, credibility, research proficiency, time management, confidentiality, adaptability, and professional independence when completing expert assignments.
Forms objective opinions based on the available evidence, reliable methods, and professional expertise rather than the desired outcome of a retaining party.
Evaluates complex billing, coding, clinical, payment, and reimbursement information using logical and supportable reasoning.
Produces reports that are organized, accurate, understandable, and sufficiently detailed to explain the basis of the expert’s analysis and opinions.
Explains technical healthcare financial concepts clearly and responds directly and professionally during testimony.
Verifies data, calculations, citations, schedules, and supporting records before issuing an opinion or report.
Demonstrates consistency, preparation, objectivity, professionalism, and respect for the limits of the expert’s expertise.
Identifies and evaluates relevant reimbursement information, billing standards, coding materials, payment data, and industry resources.
Plans and completes work in accordance with litigation schedules and applicable deadlines.
Protects case information, medical information, client information, and attorney work product.
Responds effectively to new evidence, supplemental records, revised assumptions, scheduling changes, and evolving case requirements.
The Medical Bill Review Expert Witness must be able to demonstrate that the opinions offered in a Texas matter fall within the expert’s actual qualifications and area of expertise.
The expert must use methods that can be clearly explained, consistently applied, and supported by the information reviewed.
Identify the specific subject areas in which the expert is qualified to offer opinions.
Explain how the expert’s education, training, credentials, and experience relate to those opinions.
Identify the facts, records, data, and assumptions considered; explain the methodology used to reach each material opinion; and demonstrate how the methodology was applied to the facts of the case.
Acknowledge material limitations, missing records, and contrary information.
Avoid legal conclusions or clinical opinions outside the expert’s qualifications.
Cooperate with retaining counsel regarding applicable disclosure, report, affidavit, and testimony requirements while preserving professional independence.

Skills

Medical bill review
Healthcare reimbursement analysis
Medical coding
Auditing
Revenue cycle management
Healthcare finance
Claims administration
Healthcare compliance
Payment analysis
Healthcare consulting
Reviewing medical bills
Reviewing clinical documentation
Reviewing financial documentation
Comparative charge analysis
Payment analysis
Adjustment analysis
Reimbursement analysis
Healthcare financial reporting
Healthcare claims processing
Reimbursement methodologies
CPT standards
HCPCS
ICD-10-CM
Revenue codes
Modifiers
Billing conventions
Payment models
Valuation methods
Litigation support
Report writing
Affidavit preparation
Declaration preparation
Rebuttal analysis preparation
Expert testimony
Deposition testimony
Hearing testimony
Arbitration testimony
Trial testimony
Quantitative analysis
Analytical skills
Research skills
Problem-solving
Written communication
Technical report writing
Verbal communication
Presentation skills
Attention to detail
Organization skills
Deadline management
Case-file management
Software proficiency (office, spreadsheet, document management, analytical)
Confidentiality
Judgment
Credibility
Research proficiency
Time management
Adaptability
Professional independence

Location

Remote-office environment

Work Type

Full-time

Experience Level

Substantial professional experience

Education Level

Bachelor’s degree
Advanced degree

About the Company

Medical Equation is committed to maintaining an inclusive workplace.

Equal Opportunity

Medical Equation is an equal opportunity employer committed to maintaining an inclusive workplace. Employment decisions are made without unlawful discrimination on the basis of any status protected by applicable federal, state, or local law.