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AppleOne
Certified Professional Coder
Career Insights for Medical Claims Examiner
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What they do
A Medical Claims Examiner evaluates medical insurance claims in accordance with applicable contracts and government regulations. Verifies that medical treatment costs are accurate given a patient's diagnosis. May specialize in specific types of treatments or types of drug claims.
$50,891 / year median in the U.S.
+0% projected growth
Job Description
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.