CPC & Affidavit Specialist - NYS/NY Fee Schedule

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., * 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.

• Active CPC (Certified Professional Coder) certification (AAPC)
• 3-5 years’ experience in medical coding, including:
• NYS and/or NJ Workers’ Compensation and No-Fault Insurance billing
• Fee schedule application and medical review
• ICD-10-CM, CPT, HCPCS coding systems
• 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

Preferred Qualifications

• 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, * Do you have an active CPC Certification (AAPC or equivalent)?
• Do you have experience in NYS and/or NJ Workers’ Comp billing?
• Do you have experience in NYS and/or NJ No-Fault billing?
• Do you have experience drafting affidavits/affirmations for arbitration/litigation?

$50,000 - $70,000 a year - Full-time, Pulled from the full job description

• 401(k)
• Health insurance
• 401(k) matching
• Paid time off
• Vision insurance
• Dental insurance
• Life insurance, * 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

At Managed Care Network, Inc., we specialize in delivering innovative, fast-turnaround solutions in the Property & Casualty (P&C) marketplace. We support attorneys, insurance carriers, and providers with high-quality forensic medical reviews rooted in accuracy, compliance, and legal defensibility.

Our mission is to elevate claim strategy, support arbitration and litigation efforts, and advocate for the integrity of medical necessity and billing practices. We aim to be the best employer in by fostering an environment where our employees feel empowered, supported, and appreciated for the expertise and hard work they bring. Through our Thrive values, we encourage continuous professional growth while maintaining flexibility and work-life balance.