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Casualty Bill Review Specialist

June 15, 2026

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<ul><li>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 methodologies. - Evaluate medical narratives and attachments. - Ensure compliance with prompt payment requirements.</li><li>Rules, Workflow & Pricing Management: - Configure and maintain bill review rules and workflows. - Partner with Network and Operations for pricing implementation. - Monitor system outputs and recommend improvements.</li><li>Cross-Functional Collaboration: - Collaborate with Network, Operations, IT, and vendors. - Ensure alignment of bill review strategies and processes.</li><li>Training & SME Responsibilities: - Serve as SME for New York bill review. - Develop and deliver training programs. - Create job aids and documentation.</li><li>Disputes & Compliance: - Collaborate with team members on denials, reconsiderations, and dispute processes. - Ensure WCB compliance and audit readiness.</li></ul>Essential Qualifications -At least 5 years of demonstrated expertise of New York MTGs - Expertise in NY fee schedules and reimbursement methodologies - Knowledge of CMS-1500 EDI billing - Understanding of medical narratives and attachments - Experience with WCB dispute processes - Strong knowledge of CPT, HCPCS, ICD-10 coding - Familiarity with Medical Necessity forms and Authorizations - Understanding of NY billing regulations and PAR processes - Ability to review bills for compliance - Knowledge of DME, Home Health, and Ancillary reimbursement - Understanding of prompt payment requirements AboutAt Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.Come be a part of the Brightest Ideas in Healthcare™.Company MissionTransform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.Company VisionRedefine health care quality and value by aligning the incentives of our partners in powerful and unique ways. JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: <a href="mailto:recruiting@brightonhps.com" target="_blank" title="mailto:recruiting@brightonhps.com">recruiting@brightonhps.com</a>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...