Forensic Coder

Job Title:Forensic Coder (Remote – Full-Time)Location (City, State):Remote (EST or CST Preferred; NY, NJ, and FL candidates strongly preferred)Pay: $25 - $30/hrAbout Our Client:Our client is a growing managed care organization that partners with Property & Casualty Insurance Carriers throughout New York State. They are known for providing innovative solutions, responsive service, and high-quality outcomes while supporting insurance payers through medical bill review, coding, and forensic auditing.Job Description:We are seeking an experienced Forensic Coder to join a growing team supporting Property & Casualty insurance claims. This role focuses on reviewing medical records and bills to determine medical necessity, causation, coding accuracy, and compliance with New York State fee schedules. The ideal candidate has strong coding knowledge, experience with Workers' Compensation and No-Fault claims, and enjoys investigative, analytical work.Key Responsibilities:Review medical bills and supporting clinical documentation for coding accuracy and validity.Work closely with provider billers to negotiate bills that fall outside established fee schedules.Evaluate medical records to determine the point of stabilization on cases involving DWI, syncope, heart attack, stroke, and other non-accident-related conditions.Analyze Diagnosis Related Groups (DRGs) and Enhanced Ambulatory Patient Groups (EAPGs).Ensure coding and charges are supported by appropriate clinical documentation.Prepare legally sound affidavits for arbitration and litigation.Research complex medical and coding issues related to insurance claims.Maintain compliance with New York State fee schedules and payer guidelines.May provide testimony related to audits or affidavits when required.Qualifications:CPC required; RN preferred but not required.Experience with Workers' Compensation and No-Fault Insurance claims.Strong knowledge of DRGs, EAPGs, and medical necessity review.Experience auditing medical bills and clinical documentation.Familiarity with New York State fee schedules preferred.Experience preparing affidavits or legal documentation is highly desirable.Excellent analytical, written, and verbal communication skills.Strong organizational skills with the ability to work independently and meet deadlines.Additional Details:Remote position.Approximately 40 hours per week with a flexible schedule after training.Training lasts 4–6 weeks and requires availability during normal Monday–Friday daytime business hours.Indefinite contract with no planned end date.Equipment provided.30-minute Microsoft Teams interview with a quick hiring decision.Hiring immediately.Perks:Fully remote opportunity.Flexible full-time schedule after training.Long-term contract with no defined end date.Equipment shipped directly to you.Fast interview and hiring process.Opportunity to work on specialized forensic coding and insurance cases.