Healthcare Advocate (Medical Coding)

Responsibilities

• Own high-impact medical billing and insurance cases end-to-end, from AI handoff to resolution.
• Review EOBs for coding accuracy: verify CPT, ICD-10, revenue, and modifier codes match the care received, provider type, and setting of care.
• Identify coding conflicts like unbundling, upcoding, mutually exclusive codes, or CPT/ICD-10 mismatches; escalate or dispute them.
• Contact providers and insurers via phone, email, and fax to verify coverage, correct claims, and unblock next steps.
• Investigate and triage issues across benefits, eligibility, claims, prior auth, billing codes, and payment responsibility.
• Advocate for users with persistence, clear escalation, and strong documentation.
• Communicate clearly with users, setting expectations and explaining options in plain language.
• Maintain high-quality case notes and drive improvements to playbooks and processes.
• Partner with Product and Engineering to turn case patterns into product improvements.

Requirements

Must-haves:

• 2+ years experience in patient/healthcare advocacy, medical billing, or health insurance.
• 2+ years hands-on medical billing or coding experience with knowledge of CPT, ICD-10.
• Flexible schedule for 40 hours between 7am-8pm EST, 7 days/week (e.g., Sun-Thu 9am-6pm or Tue-Sat 10am-7pm).
• Comfortable with phone-heavy follow-up and escalation.
• Strong communication with empathy and clarity.
• Thrive in ambiguity with bias for action.
• Solid understanding of HIPAA and PHI handling.

Nice-to-haves:

• Early-stage healthtech startup experience.
• CPC, CPC-H, CBCS, or equivalent certification.
• Track record catching billing errors or overturning denials.
• In-depth coding-coverage knowledge, Medicare/Medicaid experience.

Compensation

• Annual base salary starts at $50,000, varies by experience, expertise, and location.