Billing Guide - Wall, New Jersey

We’re thrilled that you are interested in joining us here at the Amynta Group!

As a Billing Guide, you’re Guided Health Concierge’s expert on medical bills and insurance claims, and you own every billing case you take on. You independently evaluate billing situations, exercise judgment in determining appropriate resolution strategies, and make recommendations based on your analysis of billing records, insurance benefits, applicable requirements, and member circumstances. You decide whether a bill is correct, choose the best path to resolve it, and decide when to dispute, escalate or appeal. You use your own judgment, not a script.


This role is an ideal fit for a medical office manager who has overseen billing and claims and wants to put that expertise to work on the member’s side.


Beyond individual cases, you’ll analyze billing and claims patterns across members, providers and carriers, find the root causes of recurring problems, and recommend changes to how we handle billing issues. You evaluate the broader operational and member impact of recurring issues and suggest recommendations to improve service delivery, reduce billing errors, and strengthen resolution practices. Your recommendations will directly shape our billing workflows, procedures and member education as we grow.


The most successful Billing Guides think proactively. You don’t just fix the bill in front of you. You look for related claims with the same problem, explain what happened so members know what to expect next time, and work with members by phone, email and our HIPAA-secure member portal until each issue is resolved. You determine the appropriate approach for each case, establish follow-up priorities based on complexity, risk, and as new information becomes available.


This is a critical role. Our Guides are our product: the experience you create for members is what our clients are buying

What you’ll do

 

• Exercise independent judgment over billing cases. Analyze itemized bills, EOBs and plan documents to determine whether a bill is correct, evaluate available resolution options, and independently determine the appropriate course of action for each case, including whether to dispute, negotiate, appeal or escalate.
• Develop strategies to resolve complex billing and claims issues. Work with provider billing offices and carriers on the member’s behalf to correct errors, reprocess claims, secure refunds or adjustments, and place accounts on hold while issues are reviewed. When a bill is correct but hard to pay, help members set up payment plans or apply for financial assistance. Assess the merits of disputed charges, determine the most effective resolution approach, and adjust strategies based on case developments and applicable plan provisions.
• Evaluate and lead appeals. Decide when an appeal is warranted, determine the arguments and supporting evidence needed to substantiate the appeal, gather records and letters of medical necessity, and see each appeal through to a decision, including external review when appropriate. Assess appeal outcomes to identify implications for future cases and recommend changes to the approach used for similar disputes.
• Analyze trends and identify root causes. Track billing and claims issues across members, providers and carriers, identify recurring problems and their root causes, and measure their impact on members. Interpret findings, evaluate potential solutions, and develop recommendations to address systemic billing issues and improve member outcomes.
• Recommend and influence process improvements. Recommend changes to billing workflows, procedures, escalation paths and member education, and help put approved changes in place. Bring these recommendations directly to the Manager of Member Services and the Chief Client Officer. Evaluate existing practices, identify opportunities to improve operational effectiveness, and develop recommendations that inform management decisions regarding billing processes, service delivery and recurring claims issues.
• Serve as the team’s billing subject-matter expert. Advise Care Guides on billing and claims questions, work together on cases that need both, and help train new team members on billing and claims. Provide guidance on complex cases, explain the reasoning behind recommended resolution strategies, and contribute expertise to the development of consistent, effective approaches to billing challenges.
• Educate members and develop recommendations for preventive education. Explain bills, EOBs, deductibles, coinsurance and out-of-pocket maximums in plain language, so members understand their benefits and can avoid future billing surprises. Identify recurring member knowledge gaps and recommend educational resources or communication approaches to prevent avoidable billing issues.
• Maintain accountability for case outcomes. Document your decisions and actions, follow up until each issue is closed, and meet the response and resolution times set in Guided Health Concierge’s service level agreements (SLAs). Exercise judgment in prioritizing cases and determining follow-up actions while maintaining accurate documentation, compliance with applicable requirements, and accountability for timely resolution.

 

What you bring

• 2+ years of experience in medical billing, claims processing or revenue cycle, ideally managing billing and claims for a medical office
• Strong knowledge of how claims are processed, including EOBs, network status, deductibles, coinsurance and out-of-pocket maximums
• Familiarity with CPT, ICD-10 and HCPCS codes and how coding errors affect what a member owes
• Experience writing clear, persuasive appeals or formal correspondence
• Sound independent judgment, and experience analyzing billing or claims problems and improving the processes behind them
• A proactive mindset: you anticipate what a member will need next, and you keep at an issue until it’s fixed, even when that takes several calls
• Empathy and strong communication skills (written and verbal), including with stressed or frustrated members
• Strong attention to detail and the ability to manage many open cases at once
• An understanding of HIPAA and how to handle protected health information
• Bachelor’s degree, or at least 5 years of medical billing or claims experience in place of a degree

Nice to have

• Experience as a medical office manager overseeing billing and claims
• Experience in a health advocacy or patient billing advocacy role
• Experience working in the health insurance space
• A medical billing and coding certification, such as CPC or CBCS
• Knowledge of the No Surprises Act, balance billing rules and the external review process
• Experience with dental and vision claims
• Bilingual in English and Spanish

Location and schedule

• Location: Central Monmouth County, New Jersey
• Schedule: Full-time, salaried position, Monday through Friday. We support members from 8 a.m. to 9 p.m. ET, and each Billing Guide covers one evening (until 9 p.m. ET) per week on a rotating basis. This schedule may change as we grow and hire team members in other time zones.
• Work model: In office Monday through Thursday. Remote on Fridays.
• Pay: $70,000 to $80,000 per year, based on experience

What we offer

• Competitive pay
• Medical, dental and vision coverage
• Flexible spending account (FSA) or health savings account (HSA), with a company contribution to the HSA
• Company-paid life insurance
• Paid time off and company holidays
• Remote Fridays
• Thorough training on our tools, carriers and processes
• Many additional benefits
• The opportunity to make a difference at a new company

The Amynta Group (the “Company”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of any ground of discrimination protected by applicable human rights legislation. The information collected is solely used to determine suitability for employment, verify identity and maintain employment statistics on applicants.

Applicants with disabilities may be entitled to reasonable accommodation throughout the recruitment process in accordance with applicable human rights and accessibility legislation. A reasonable accommodation is an adjustment to processes, procedures, methods of conveying information and/or the physical environment, which may include the provision of additional support, in order to remove barriers a candidate may face during recruitment such that each candidate has an equal employment opportunity. The Company will accommodate a candidate to the point of undue hardship. Please inform the Company's personnel representative if you require any accommodation in the application process.