Job Description

Medical Billing Audit Specialist 

Location: San Antonio, TX/ Tampa, FL (On site)
Type: Contract | Full-time
Pay Rate: $20-$25/hr

Role Summary

Acts as the primary liaison and support resource for Injury/Casualty Adjusters supporting Medical Bill Audit (MBA) operations in MedFlow. Provides hands-on claims and system support, helps reduce medical bill backlogs, improves adjuster efficiency, and ensures compliance with service level objectives and state regulations. First Party personal injury claims experience is REQUIRED.

Required Qualifications

• Experience handling first-party personal injury claims
• Strong background in medical bill processing, auditing, or adjudication
• Experience working with third-party medical bill processing vendors
• Understanding of medical billing concepts, including CPT codes and ICD-9/ICD-10
• Ability to analyze workflows and use data analysis to troubleshoot process issues or propose solutions
• Proven ability to explain complex systems to non-technical audiences
• Strong communication and stakeholder management skills
• Comfortable working independently while coordinating across teams
• Leadership experience or demonstrated ability to guide and influence others

Key Responsibilities

• Audit and review medical bills related to personal injury auto claims
• Understand and apply coverage determinations and billing rules
• Serve as a liaison between claims adjusters, medical bill vendors, and internal teams
• Coordinate with vendor partners to understand workflows, system rules, and processing logic
• Translate vendor system outputs and recommendations into clear guidance for adjusters
• Route medical bills and exceptions appropriately within adjuster workflows
• Identify bottlenecks, exceptions, and inefficiencies in medical bill processing
• Troubleshoot issues related to vendor platforms (e.g., Medflow dashboards or APIs)
• Make process improvement recommendations, including opportunities to automate workflows and reduce exceptions
• Develop reporting and insights based on trends observed in medical billing and adjudication
• Provide leadership and guidance to adjusters and vendor partners when issues arise
• Address escalations and coordinate solutions across teams

Preferred / Nice-to-Have

• Experience with Medflow or similar medical bill ingestion platforms
  (AIS / CCCIS experience is not required)
• Familiarity with API-based or dashboard-driven medical billing systems
• Experience reducing manual handling, improving automation, or minimizing exceptions
• Background working with auto insurance claims organizations