Job Description

Job Title: Forensic Medical Coder

Industry: Managed Care / Insurance Services

Location (City, State): Remote (EST or CST Preferred; candidates located in NY, NJ, or FL are highly encouraged to apply)

Compensation: $25.00 - $30.00 per hour

Benefits: This position is eligible for medical, dental, vision, and 401(k).

Work Schedule: Full-Time | Approximately 40 hours per week. Standard business-hour availability required during training, with schedule flexibility available afterward.

About Our Client:

Addison Group is partnering with our client to identify a skilled Forensic Medical Coder for a fully remote opportunity. This position supports insurance-related claim reviews through detailed analysis of medical records, billing documentation, and coding practices. The ideal candidate enjoys investigative work, has strong medical coding expertise, and can effectively interpret clinical information within a regulatory environment.

Job Description:

The Forensic Medical Coder will be responsible for reviewing healthcare claims and supporting documentation to ensure coding accuracy, medical necessity, and compliance with applicable reimbursement guidelines. This role combines medical coding knowledge with analytical review skills to assist in claim evaluation, dispute resolution, and audit-related activities.

Key Responsibilities:

• Conduct detailed reviews of medical billing records and clinical documentation to validate coding accuracy and charge appropriateness.
• Assess healthcare claims to determine whether services meet established medical necessity and reimbursement criteria.
• Collaborate with healthcare providers and billing representatives to address coding discrepancies and resolve payment-related issues.
• Analyze complex cases involving non-accident medical events and evaluate supporting records to determine appropriate claim outcomes.
• Review inpatient and outpatient reimbursement methodologies, including diagnosis and procedure grouping classifications.
• Verify that submitted charges are adequately supported by physician documentation and treatment records.
• Prepare comprehensive written findings and supporting documentation for claim disputes, arbitration matters, and other formal proceedings.
• Investigate complex coding and reimbursement questions while applying payer guidelines and regulatory requirements.
• Maintain current knowledge of applicable fee schedules, coding updates, and industry standards.
• Participate in audit-related activities and provide subject matter expertise when needed.

Qualifications:

• Certified Professional Coder (CPC) certification required.
• Nursing background (RN) is a plus but not required.
• Experience reviewing Workers’ Compensation and/or No-Fault insurance claims.
• Strong understanding of medical necessity determinations and coding audit methodologies.
• Knowledge of reimbursement groupers and payment methodologies, including DRG and ambulatory payment systems.
• Previous experience auditing medical records, claims, and billing documentation.
• Familiarity with state-specific fee schedules and insurance claim review processes is preferred.
• Experience drafting formal reports, affidavits, or other legal-support documentation is highly desirable.
• Strong critical thinking, communication, and organizational skills.
• Ability to work independently while managing priorities in a remote environment.

Perks:

• 100% remote work environment.
• Flexible scheduling following completion of training.
• Long-term contract opportunity with ongoing stability.
• Company-provided equipment.
• Streamlined interview and onboarding process.
• Opportunity to develop expertise within a specialized area of medical coding and insurance claim review.
• Collaborative team environment with continued learning opportunities.

Additional Details:

• Full-time remote position.
• Initial training period of approximately 4–6 weeks conducted during standard weekday business hours.
• Equipment provided for remote work.
• Long-term contract assignment with no anticipated end date.
• Immediate hiring need with an expedited interview process.

Addison Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected status under applicable federal, state, or local law. Reasonable accommodations are available for qualified individuals with disabilities upon request.

#HC1

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