About The Role

The Casualty Bill Review Specialist is responsible for ensuring accurate, compliant, and efficient medical bill review within the New York workers’ compensation and casualty environment. This role serves as a subject matter expert (SME) in New York and other state regulations, partnering closely with Network, Operations, and cross-functional teams to ensure proper configuration of bill review processes, rules, workflows, and pricing implementation. The Specialist is also responsible for training interdepartmental staff on applicable rules, policies, procedures, and regulatory requirements.
*This is a remote role.

Primary Responsibilities

+ Bill Review & Regulatory Compliance:
- Review medical bills for accuracy, coding validity, and compliance with New York Workers’ Compensation Board (WCB) regulations.
- Apply New York Medical Treatment Guidelines (MTGs).
- Ensure proper application of New York fee schedules and reimbursement met...