Job ID: 1801056
Reference Code: CL MancareCoder8-5
Job Summary
A direct hire opportunity is available for an experienced Certified Professional Coder based in Grand Island, NY. This role is ideal for a detail-oriented CPC professional with strong medical coding, fee schedule, bill review, and clinical documentation knowledge who wants to apply their expertise in a specialized 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, reimbursement review, and legal documentation.
This is a strong fit for someone who values accuracy, autonomy, supportive leadership, and a collaborative professional team. The environment offers stability, work-life balance, comprehensive benefits, and the chance to use advanced coding knowledge in a meaningful and highly specialized 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, including upcoding, unbundling, non-compliant billing practices, and charges outside fee schedule parameters.
- Prepare detailed counter-affidavits, affirmations, cost reports, and written findings 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 per year.
- 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
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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.
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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 audit medical bills, coding, and clinical documentation for accuracy and compliance.
- Analyze complex claims involving no-fault, workers' compensation, and personal injury matters.
- Prepare written findings, cost reports, counter-affidavits, and related documentation for legal and insurance review.
- Identify coding, billing, and reimbursement discrepancies using applicable fee schedules and coding guidelines.
- Certified Professional Coder certification required.
- 3 to 5 years of professional medical coding, bill review, or related healthcare reimbursement experience.
- Strong knowledge of CPT, HCPCS, ICD coding, medical terminology, and clinical documentation standards.
- Ability to interpret fee schedules, coding guidelines, medical records, and payer requirements.
- High attention to detail with strong analytical, documentation, and written communication skills.
- Ability to work independently in a remote environment while meeting deadlines and maintaining confidentiality.
- Commitment to HIPAA compliance and professional handling of sensitive medical and legal information.
Preferred Qualifications
- Experience with NYS and/or NJ Workers' Compensation and No-Fault Fee Schedules.
- Background in medical bill review, utilization review, insurance claims, legal support, or forensic medical review.
- Experience preparing written findings or documentation used in arbitration, litigation, or court-related matters.
- Familiarity with identifying upcoding, unbundling, medical necessity concerns, and non-compliant billing practices.