Healthcare Advocate (Medical Coding)

💡 MISSION The US healthcare system is complex, error-prone, and financially draining. Medical bills and insurance coverage shouldn’t be this hard to navigate. At Granted, we’re building the one solution every American can turn to for help. Thanks to AI and new regulations, Granted can fight claim denials, correct billing errors, negotiate bills, and make coverage easier to understand—saving people time, money, and stress. Our goal is simple: to be the #1 platform that empowers all Americans to take charge of their healthcare 🩺 ABOUT US Founded by a former Oscar Health leader, we’re a seed-stage company with $17M in funding. We’re lucky to be backed by the founders and investors at Hugging Face, Rocket Money, Oscar Health, CaseText, Forerunner Ventures, RRE Ventures, and more. We are well-funded for the next few years. 🔎 ABOUT THE ROLE The Customer Experience (CX) team delivers high-quality support that helps Granted users navigate the U.S. healthcare system with less time, cost, and stress. We're growing quickly, and we're hiring Healthcare Advocates (HA) to take on more complex cases and raise the bar on what "great support" looks like as we scale. As a HA, you'll own high-impact medical billing and insurance cases end-to-end. Our AI agent will handle the initial intake and information gathering, then hand cases to you when judgment, persistence, and human advocacy are needed to get to resolution. A core part of this role is validating that the billing on an EOB actually reflects the care the patient received, catching code-level errors that drive incorrect charges before they become bigger problems. You'll work on a small, high-trust team and partner closely with Product and Engineering to turn frontline learnings into better workflows and a better user experience. What you’ll own: - You will own a case from handoff to resolution, including next steps, outreach strategy, documentation, and follow-through. - You will assess whether the procedure, diagnosis, and modifier codes on an EOB are consistent with the service described, the setting of care, and what the patient reports actually happened at the visit. - You will identify coding conflicts, such as unbundling, upcoding, mutually exclusive codes, or CPT/ICD-10 combinations that don't hold up, and escalate or dispute them with the appropriate party. - You will decide how to route each situation (provider billing department, insurer, collections, employer plan, or user education) and what "done" looks like. - You will be accountable for timely, accurate outcomes and a high-quality user experience, even when the path is unclear. - You will drive improvements to playbooks and internal processes based on real case patterns. 🛠️ WHAT YOU’LL DO - Resolve complex user cases end-to-end, from AI handoff through final outcome. - Review EOBs for coding accuracy: verify that CPT, ICD-10, revenue, and modifier codes match the care actually received, the provider type, and the setting of care (inpatient vs. outpatient, facility vs. professional, etc.). - Identify and flag code-level billing errors: duplicate billing, bundling violations (e.g., billing component codes when a global code applies), mutually exclusive code pairs, incorrect place-of-service codes, and procedure/diagnosis mismatches. - Contact providers and insurers via phone, email, and fax to verify coverage, correct claim and billing issues, and unblock next steps. - Investigate and triage issues across benefits, eligibility, claims, prior auth, billing codes, and payment responsibility. - Advocate for the user by pushing cases forward with persistence, clear escalation paths, and strong documentation. - Communicate clearly with users, setting expectations, sharing progress, and explaining options in plain language, including when a coding error is the root cause. - Maintain high-quality case notes so anyone can understand what happened, what changed, and what to do next. - Continuously learn healthcare regulations, payer behavior, coding guidelines, and internal playbooks, and apply that learning quickly. - Improve how we operate by collaborating with other healthcare advocates, identifying repeat billing patterns, tightening workflows, and helping build playbooks that scale in an early-stage environment. - Partner with Product and Engineering to turn real case patterns into product improvements and better automation. 👩‍💻 WE’LL BE MOST EXCITED IF YOU Must-haves: - 2+ years of experience in patient/healthcare advocacy, medical billing, or health insurance - 2+ years of hands-on experience in medical billing or coding, with working knowledge of CPT, ICD-10, and how codes translate to patient financial responsibility. - Formal coding certification (CPC, CPC-H, or equivalent) is a plus but not required. - Flexible schedule to work 40 hours between 7am - 8pm EST, 7 days/week. To start, you’ll either work: - Sunday – Thursday, 9am–6pm, or - Tuesday – Saturday, 10am–7pm - You are comfortable working directly with provider offices, health insurers and debt collection groups, including phone-heavy follow‑up and clear escalation when needed. - You communicate with empathy and clarity, especially when delivering hard news or complex explanations. - You thrive in ambiguity, and move cases forward with a bias for action, choosing the right next step, without perfect information. - You take documentation seriously and protect user privacy, with a solid working understanding of HIPAA and PHI handling. - You are mission-driven and are passionate about helping build a new standard for how people get help navigating U.S. healthcare. Nice-to-haves: - Early-stage (Series B or earlier) or healthtech startup experience. - CPC, CPC-H, CBCS, or equivalent medical coding certification. - Demonstrated track record of catching billing errors that reduced patient financial liability, overturned denials tied to coding issues, or corrected claims with incorrect codes. - In-depth understanding of how coding intersects with coverage determinations, especially in complex cases involving prior auth, medical necessity language, or claim denials citing incorrect procedure codes. - Experience with Medicare, Medicare Advantage, and/or Medicaid billing rules, including how coding guidelines differ across payer types. Additional details: - In compliance with applicable pay transparency laws, the good-faith annual base salary typically starts at $50,000. Individual compensation will vary based on experience, relevant expertise, and geographic location. - Preferred hiring locations: New York, Texas, Ohio