Billing Guide - Wall, New Jersey

Amynta Group • NJ - Remote, NJ

10d • $70,000 - $80,000 • Hybrid

About The Position

The Billing Guide is Guided Health Concierge’s subject-matter expert on medical bills and insurance claims, responsible for independently evaluating billing cases and choosing appropriate resolution strategies based on billing records, insurance benefits, applicable requirements, and member circumstances. The role uses professional judgment—not scripts—to determine whether bills are correct and whether to dispute, negotiate, appeal, escalate, or pursue another resolution.

Billing Guides work directly with members by phone, email, and a HIPAA-secure member portal, following cases through to resolution. They also work with provider billing offices and insurance carriers to correct errors, reprocess claims, obtain refunds or adjustments, and address payment difficulties. The role includes leading appeals, advising Care Guides, and helping train new team members.

Beyond individual cases, the Billing Guide tracks recurring billing and claims issues, identifies root causes, assesses their impact on members, and recommends operational changes. Recommendations may shape billing workflows, procedures, escalation paths, and member education. The position is full-time and salaried, based in Central Monmouth County, New Jersey, with in-office work Monday through Thursday and remote work on Fridays. Guides cover one evening per week until 9 p.m. ET on a rotating basis; the schedule may change as the organization grows.

Requirements

• At least 2 years of experience in medical billing, claims processing, or revenue cycle, ideally managing billing and claims for a medical office.
• Strong knowledge of claims processing, including EOBs, network status, deductibles, coinsurance, and out-of-pocket maximums.
• Familiarity with CPT, ICD-10, and HCPCS codes and how coding errors affect member responsibility.
• Experience writing clear, persuasive appeals or formal correspondence.
• Sound independent judgment and experience analyzing billing or claims problems and improving related processes.
• Proactive approach, including anticipating member needs and persistently following issues through to resolution.
• Empathy and strong written and verbal communication skills, including communicating with stressed or frustrated members.
• Strong attention to detail and ability to manage many open cases at once.
• Understanding of HIPAA and handling protected health information.
• Bachelor’s degree, or at least 5 years of medical billing or claims experience in place of a degree.

Nice To Haves

• Experience as a medical office manager overseeing billing and claims.
• Experience in health advocacy or patient billing advocacy.
• Experience working in the health insurance space.
• 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 proficiency in English and Spanish.

Responsibilities

• Independently review itemized bills, EOBs, and plan documents to determine whether bills are correct and select an appropriate resolution strategy.
• Work with provider billing offices and insurance carriers to correct errors, reprocess claims, secure refunds or adjustments, and place accounts on hold during review.
• Help members arrange payment plans or apply for financial assistance when bills are correct but difficult to pay.
• Decide when appeals are warranted, determine arguments and supporting evidence, gather records and letters of medical necessity, and follow appeals through decisions, including external review when appropriate.
• Review appeal outcomes and recommend changes to approaches used for similar disputes.
• Track billing and claims issues across members, providers, and carriers; identify root causes; and evaluate their impact on members.
• Develop recommendations to address systemic billing issues and improve member outcomes, workflows, procedures, escalation paths, and member education; help implement approved changes.
• Bring process-improvement recommendations to the Manager of Member Services and the Chief Client Officer.
• Advise Care Guides on billing and claims questions, collaborate on cases, and help train new team members.
• Explain bills, EOBs, deductibles, coinsurance, and out-of-pocket maximums to members in plain language.
• Identify recurring member knowledge gaps and recommend preventive educational resources or communications.
• Document decisions and actions, prioritize follow-up, keep cases moving until closure, and meet service-level agreement response and resolution times.
• Maintain accurate documentation, comply with applicable requirements, and remain accountable for timely case resolution.

Benefits

• 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 tools, carriers, and processes.
• Many additional benefits.
• Competitive pay.
• Opportunity to make a difference at a new company.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level