Fee Schedule Specialist

Job Summary

We are seeking a detail-oriented Fee Schedule Specialist for a temp-to-hire opportunity in Grand Island, NY. This role is ideal for a medical billing, coding, or bill review professional who enjoys analytical work, reimbursement accuracy, and healthcare claims compliance.

The Fee Schedule Specialist will review and process medical bills for New York State Workers' Compensation and Auto/No-Fault claims, applying fee schedules, Medicare methodologies, PPO contracts, and client-specific reimbursement guidelines. This is an excellent opportunity to grow within the healthcare reimbursement and insurance services field while working with experienced professionals in a collaborative, supportive environment.

This position offers strong career development potential, exposure to specialized reimbursement practices, and a hybrid schedule with potential to transition to fully remote work. Candidates with CPC-A, CPB, CPC, or related certifications are strongly encouraged to apply.

Key Responsibilities

- Review and analyze medical bills, records, and supporting documentation for accuracy, compliance, and reimbursement determination.
- Apply New York State Workers' Compensation and Auto/No-Fault fee schedules, Medicare methodologies, PPO contracts, and client-specific reimbursement guidelines.
- Interpret CPT, HCPCS, ICD-10 codes, modifiers, and medical terminology to identify billing discrepancies and determine appropriate reimbursement.
- Generate accurate Explanations of Benefits, C-8s, C-8.1 forms, and other required regulatory notices.
- Communicate professionally with providers, adjusters, clients, and internal teams to resolve billing and documentation issues.
- Manage assigned bill review inventory to meet productivity, quality, and turnaround time expectations.

Compensation and Benefits

- Compensation: $50,000 to $65,000 annually.
- Job Type: Direct Hire or Temp-to-Perm after 720 hours.
- Schedule: Monday-Friday, 8:00 AM to 4:30 PM.
- Location: Grand Island, NY 14072.
- Workplace Type: Hybrid with potential to transition to fully remote.
- Start Date: ASAP.
- 401(k) with 3% company match.
- Health insurance plans available.
- Dental insurance plans available.
- 10 days of Paid Time Off annually.
- 5 New York State paid sick days.
- Professional growth and development opportunities.

Equal Opportunity Employer / Disabled / Protected Veterans

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For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

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We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Additional Skills

Required Qualifications and Skills

- Review medical bills and supporting documentation for reimbursement accuracy and regulatory compliance.
- Apply Workers' Compensation, Auto/No-Fault, Medicare, PPO, and client-specific reimbursement guidelines.
- Identify billing errors such as duplicate charges, unbundling, incorrect modifier usage, excessive fees, and unsupported services.
- Maintain accurate documentation of findings, reimbursement decisions, and actions taken in internal systems.

- High school diploma or equivalent required.
- 1-2 years of experience in medical billing, medical coding, bill review, or a related healthcare reimbursement role preferred.
- Strong understanding of medical terminology, billing practices, and reimbursement concepts.
- Proficiency with Microsoft Office applications, including Excel and Outlook.
- Strong analytical, organizational, and problem-solving skills.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities in a fast-paced, production-focused environment.
- Ability to work independently while contributing effectively within a team.
- Legal authorization to work in the United States.

Preferred Qualifications

- CPC-A, CPB, CPC, or related certification.
- Additional healthcare, billing, or coding education.
- Working knowledge of New York State Workers' Compensation and/or Auto/No-Fault billing practices.
- Familiarity with CPT, HCPCS, and ICD-10 coding systems and reimbursement methodologies.
- Experience using bill review platforms such as Strataware, Conduent, Medata, Mitchell, or similar systems.
- Experience in Workers' Compensation, Auto Insurance, healthcare reimbursement, payer-side operations, or medical bill review.
- Strong attention to detail and commitment to accuracy.