Job Description

Location: Remote (Northeast U.S.)

Schedule: Monday–Friday | 8:00 AM–4:30 PM (Flexible)

Hours: Candidates must be available to work standard East Coast (Eastern Time) business hours.

Employment Type: Direct Hire
Salary: $60,000–$70,000 annually

About the Role

Large medical claims support company is seeking an experienced Certified Medical Coder (CPC) to join their Bill Review team. This position is ideal for a detail-oriented coding professional with experience reviewing medical bills for New York and/or New Jersey Workers' Compensation and No-Fault claims. In this role, you will analyze medical records and billing documentation, audit coding accuracy, determine compliance with applicable fee schedules, and prepare written reports to support legal proceedings. The ideal candidate has strong analytical skills, extensive knowledge of medical coding guidelines, and the ability to communicate findings clearly and professionally. This is a remote opportunity offering flexible scheduling, independent case management, and the opportunity to work on complex medical billing reviews.

Key Responsibilities

- Review physician and facility medical bills for compliance with New York and New Jersey Workers' Compensation and No-Fault fee schedules.

- Audit medical claims using ICD-10-CM, CPT, HCPCS, DRG, and related coding systems.

- Analyze clinical documentation to determine medical necessity and patient stabilization in complex cases.

- Identify coding discrepancies, including upcoding, unbundling, and other billing inaccuracies.

- Prepare detailed cost reports, affidavits, and written findings to support legal proceedings, arbitrations, and claim resolution.

- Collaborate with internal teams and healthcare providers to evaluate bills that fall outside standard fee schedule guidelines.

- Utilize coding resources and audit databases such as Optum 360, Context 4, and Find-A-Code to support claim reviews.

- Maintain accurate documentation while ensuring HIPAA compliance and confidentiality.

- Provide administrative support to the Bill Review Department to ensure efficient day-to-day operations.

- Stay current on coding regulations, payer guidelines, and applicable state and federal requirements.

- Serve as an expert witness or provide testimony in legal proceedings when required.

Qualifications

- Active Certified Professional Coder (CPC) certification through AAPC or equivalent certification (such as CCS through AHIMA).

- 3–5 years of professional medical coding experience.

- Experience with New York and/or New Jersey Workers' Compensation and No-Fault billing and fee schedules.

- Strong knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, CDT, DRG, and EAPG coding methodologies.

- Experience performing coding audits and medical bill reviews.

- Excellent analytical, organizational, and written communication skills.

- Ability to work independently in a deadline-driven environment.

- Must be legally authorized to work in the United States.

- Must be available to work standard Eastern Time (ET) business hours. 

Equal Opportunity Employer / Disabled / Protected Veterans

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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.

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.

Additional Skills

Preferred Qualifications

- Experience with forensic medical coding or litigation support.

- Background preparing affidavits, affirmations, or cost reports for arbitration or court proceedings.

- Experience determining medical stabilization for complex claims.

- Familiarity with auto liability, personal injury, No-Fault, or Workers' Compensation claims.

- Previous experience providing expert testimony or participating in legal proceedings.

Job Tags

Temporary work, Remote work, Monday to Friday, Flexible hours

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