Forensic Medical Coder & Affidavit Specialist (Remote)

Managed Care Network, Inc.; Town of Grand Island (NY); Hybrid; USD 50,000 - 70,000; Full time

Job summary

Managed Care Network, Inc. seeks an experienced Certified Professional Coder (CPC) with a background in NYS/NJ fee schedules and forensic medical review. You will evaluate complex medical bills, audit coding practices, determine medical necessity and stabilization points, and draft affidavits for legal proceedings.

You will work remotely and independently, managing a portfolio of cases and may testify in arbitrations or court. Hybrid or remote positions are available.

Qualifications

• 3–5 years’ experience in medical coding, including NYS and/or NJ Workers’ Compensation and No-Fault billing.
• Experience drafting affidavits/affirmations for arbitration or litigation.
• Willingness to testify or be deposed as an expert.

Responsibilities

• 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.
• Identify upcoding, unbundling, and other billing discrepancies.
• Prepare counter-affidavits or cost reports to reflect UCR values and support legal teams.

Skills

Medical coding

Legal writing

Independent work

Attention to detail

Communication

Tools

Optum 360

Context 4

Find-A-Code

ICD-10-CM

Job description

Certified Medical Coder & Affidavit Specialist

Company Overview

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 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.

Position Summary

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 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 may be required to provide expert testimony in arbitrations or court.

Key Responsibilities

Review physician and facility billing to verify compliance with New York and New Jersey Workers’ Compensation requirements and No-Fault Fee Schedules.

Identify potential clinical issues that may benefit from a review by a clinical Nurse Auditor.

Audit billed services using recognized industry databases. Apply standard coding edits that align with the jurisdiction and insurance line of business.

Prepare affidavits, counter-affidavits or cost reports that accurately reflect usual, customary, and reasonable (UCR) values and support legal teams in arbitration or trial proceedings.

Collaborate, as needed, with internal teams and provider billing representatives to evaluate and negotiate charges outside applicable fee schedule parameters.

Communicate findings clearly in writing, using legally sound language suitable for submission to a court.

May provide expert testimony or participate in depositions, as required, regarding findings and affidavit content.

Maintain strict confidentiality and ensure compliance with HIPAA requirements at all times.

Remain current with applicable coding regulations, insurance requirements, and legal standards.

Maintain coding certification including completion of required CEU’s.

Must demonstrate willingness to work in harmony with others and exhibit positive behavior on a regular basis.

Required Qualifications

• Active CPC (Certified Professional Coder) certification (AAPC) or its equivalence

Apprentices will be considered on an individual basis

3–5 years’ experience in medical coding, including:

Workers’ Compensation and No-Fault Insurance billing

Fee schedule application and medical review

ICD-10-CM, CPT, HCPCS coding systems

Exceptional attention to detail and documentation quality.

Strong written communication and legal writing skills.

Ability to work independently with minimal oversight in a fast-paced environment with quick turnaround times.

Knowledge of coding systems: ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, CDT, DRG

Willingness to testify or be deposed if required

Must be legally authorized to work in the United States

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Preferred Qualifications

Prior experience with NYS Workers’ Compensation and No-Fault billing

Prior experience working with industry-known Bill Review software

Prior experience with forensic medical coding or legal proceedings

Experience testifying in legal or arbitration settings

Why Work With Us?

Hybrid/remote work environment available

Opportunities for expert testimony (additional compensation available)

Supportive, knowledgeable team focused on innovation and integrity and streamlined workflows

Meaningful work that directly impacts legal outcomes

A culture rooted in respect, transparency, and professional growth

401(k) with company match

Health insurance and Health Savings Account (HSA)

Vision Insurance

Life and disability Insurance

Paid time off (PTO)

Location Hybrid or Remote Positions Available

Salary Range $50,000 - $60,000 per year

Managed Care Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran or military status, marital status, sexual orientation, gender identity or expression, familial status, domestic violence victim status, arrest or conviction record, or any other characteristic protected by federal, state, or local law. All inquiries are held in strict confidence.an overview of the position here.