Job ID: 1797014
Reference Code: CL-MancareCertified Coder7-15
Job Summary
We are seeking an experienced Certified Professional Coder for a direct hire opportunity based in Grand Island, NY. This role is ideal for a detail-oriented CPC professional who wants to apply medical coding, fee schedule, bill review, and clinical documentation expertise in a meaningful legal, insurance, and forensic medical review environment.
The Certified Professional Coder will support complex medical bill review matters involving no-fault, workers' compensation, and personal injury claims. This position offers a remote work environment, flexible scheduling, and the opportunity to work independently while contributing to high-impact case analysis, legal documentation, and reimbursement review.
This is a strong opportunity for a coding professional who values accuracy, autonomy, supportive leadership, and a collaborative team environment. The role offers stability, competitive compensation, comprehensive benefits, and the ability to use advanced coding knowledge in a specialized professional setting.
Key Responsibilities
- Review physician and facility bills for compliance with NYS and/or NJ Workers' Compensation and No-Fault Fee Schedules.
- Audit medical bills, coding practices, and clinical documentation using industry-standard coding resources and databases.
- Evaluate medical necessity, coding accuracy, stabilization points, and appropriateness of billed services for complex medical claims.
- Identify billing discrepancies such as upcoding, unbundling, non-compliant billing practices, and charges outside fee schedule parameters.
- Prepare detailed counter-affidavits, affirmations, cost reports, and written findings suitable for arbitration, litigation, and court submissions.
- Collaborate with internal teams and provider billing representatives while maintaining HIPAA compliance and strict confidentiality.
Compensation and Benefits
- Direct hire opportunity.
- Compensation: $50,000 to $70,000 annually.
- Schedule: Monday through Friday, 8:00 AM to 4:30 PM.
- Flexible schedule.
- Remote work environment.
- 401(k) with 3% company match.
- Health insurance options.
- Dental insurance.
- Health Savings Account.
- Life insurance.
- Disability insurance.
- 10 days PTO annually.
- 5 New York State sick days.
Equal Opportunity Employer / Disabled / Protected Veterans
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Required Qualifications and Skills
- Review and analyze medical bills for NYS and/or NJ fee schedule compliance.
- Prepare affidavits, affirmations, cost reports, and legally defensible written findings.
- Evaluate medical necessity, coding accuracy, clinical documentation, and stabilization points.
- Support arbitration, litigation, deposition, or testimony needs related to coding audits and billing reviews.
- Active Certified Professional Coder credential through AAPC, or equivalent certification such as CCS through AHIMA.
- 3 to 5 years of medical coding experience.
- Experience with NYS and/or NJ Workers' Compensation billing, No-Fault Insurance billing, fee schedule application, and medical bill review.
- Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, CDT, DRG methodologies, and EAPGs.
- Experience using coding audit tools and UCR databases such as Optum 360, Context 4, and Find-A-Code.
- Ability to identify upcoding, unbundling, coding discrepancies, and non-compliant billing practices.
- Experience preparing affidavits or affirmations for arbitration, litigation, or administrative proceedings.
- Strong legal and professional writing skills with exceptional attention to detail.
- Ability to work independently in a deadline-driven environment with minimal supervision.
- Willingness to testify or be deposed regarding audits, reports, and affidavit findings when necessary.
- Must be legally authorized to work in the United States.
Preferred Qualifications
- Experience in forensic medical coding and medical-legal case review.
- Ability to determine medical stabilization points for complex claims involving DWI-related incidents, syncope, cardiac events, stroke, or other non-accident-related medical conditions.
- Previous expert witness, deposition, or arbitration testimony experience.
- Background supporting auto/no-fault, workers' compensation, or personal injury litigation.