We are seeking an experienced, detail-oriented Certified Professional Coder (CPC) with a background in NYS and/or NJ fee schedules and forensic medical case review. This per diem role is ideal for independent coders interested in combining medical expertise with legal impact. In this role, you will evaluate complex medical bills, audit coding practices, determine medical necessity and stabilization points, and draft counter-affidavits or cost reports for legal proceedings.

The ideal candidate has deep knowledge of no-fault and workers’ compensation billing, is confident writing affidavits and affirmations, and can assess stabilization points for complex, non-accident-related cases.

You will work remotely and independently, managing your own portfolio of cases, and may be required to provide expert testimony in arbitrations or court. Provide administrative support to the Bill Review Department to ensure smooth daily operation:

· Review physician and facility bills to determine compliance with NYS/NJ Workers' Compensation and No-Fault Fee Schedules


· Analyze complex clinical documentation to determine point of stabilization in cases such as DWI, syncope, cardiac events, or stroke


· Audit billed services using industry-standard databases (e.g., Optum 360, Context 4, Find-A-Code)


· Identify upcoding, unbundling, and other billing discrepancies


· Prepare counter-affidavits or cost reports to reflect UCR (usual, customary, reasonable) values and support legal teams in arbitration or trial


· Collaborate with internal teams and provider billers to assess and negotiate bills outside of fee schedule parameters


· Communicate findings clearly in writing, using legally sound language appropriate for submission to court


· Be willing to testify or be deposed as an expert regarding your findings and affidavit content


· Maintain confidentiality and ensure HIPAA compliance at all times


· Testify as needed in support of audits or affidavits authored.


· Stay up to date with relevant coding regulations, insurance requirements, and legal standards.



Days: M-F

Shifts: 8-4:30 PM (schedule is flexible)


Pay: $50-$70K



Workplace Type: Remote


Required Qualifications:


· Active CPC (Certified Professional Coder) certification (AAPC) or equivalent (e.g., CCS through AHIMA).


· 3-5 years of experience in medical coding, including:


o NYS and/or NJ Workers’ Compensation and No-Fault Insurance billing


o Fee schedule application and medical review


o ICD-10-CM, CPT, HCPCS coding systems


o DRGs and EAPGs familiarity


· Demonstrated experience drafting affidavits/affirmations for arbitration/litigation.


· Exceptional attention to detail and documentation quality.


· Strong written communication and legal writing skills.


· Ability to work independently with minimal oversight in a deadline-driven environment.


· Knowledge of coding systems: ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, CDT, DRG


· Proficient in the use of coding audit tools and UCR databases (e.g., Optum 360, Context 4, Find-A-Code)

· Willingness to testify or be deposed if required


· Must be legally authorized to work in the United States



Ideal Candidate:


· Prior experience with forensic medical coding or legal proceedings


· Ability to determine medical stabilization in complex claims


· Experience testifying in legal or arbitration settings


· Background in auto/no-fault, workers' compensation, or personal injury law support




Benefits: 3% matching 401k with company contribution, PTO starts at 10 PTO days in addition to NYS 5 sick days, health/dental plans available, HSA, life and disability insurance

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.