Authorization and Appeal Resolution Specialist | Medical Billing
Job Description
The Authorization and Appeal Resolution Specialist is responsible for tracking authorization and appeal status. This role ensures that appeals are properly submitted, tracked and followed up on until resolution.
The ideal candidate should be able to manage appeal and dispute cases from review to resolution while ensuring accurate documentation, timely follow-up and proper coordination with payers and internal teams.
Schedule: Full-time, night shift (aligned with U.S. business hours). Work setup: on-site, Quezon City.
Key Responsibilities
- Review denied or disputed authorizations, appeals or claims
- Investigate denial reasons and determine the required next steps
- Follow up on pending appeals to ensure timely resolution
- Track appeal status and update internal records
- Communicate professionally with insurance companies and internal teams
- Escalate complex or unresolved disputes when needed
- Ensure all appeal submissions follow company and payer guidelines
Skills and Qualifications
- Knowledge of insurance authorizations, claims, denial management and payer portals
- Strong attention to detail and documentation skills
- Good communication and follow-up skills
- Organized and able to manage multiple cases within deadlines
Requirements
- Experience in claims, billing, collections, appeals or dispute resolution
- Background in substance abuse, behavioral health or mental health billing
- Able to commute reliably to Quezon City or willing to relocate before starting