Certified Medical Coder

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.

This company offers growth and a great group of people to work with.