Medical Biller

Role: Medical Biller (Authorization Specialist)

Contract: Part-time Remote Contractor (80 hours monthly)

Business Hours: Monday through Friday, Flexible within 8 AM - 4 PM EST

Rate: $11 - $15 USD hourly / $880 - $1,200 monthly (Salary is negotiable depending on experience and location)

Availability to Start: Immediately

Company Profile

This established Maryland-based mental health and rehabilitation center specializes in delivering compassionate, patient-centered care for individuals seeking support with psychiatric conditions, substance abuse recovery, and physical rehabilitation. With a strong focus on personalized treatment, the center provides services in psychiatric rehabilitation, substance abuse programs, sports therapy, and medication-assisted treatment.

What You'll Do

As an Authorization Specialist, you will be the critical link between clinical care and financial sustainability in a behavioral health and substance use disorder (SUD) setting, ensuring patients receive timely authorization approvals for essential treatments such as MAT (Medication-Assisted Treatment) and intensive outpatient care. Responsibilities include, but are not limited to:

Core Responsibilities:

Authorization Management & Payer Communication

• Verify insurance eligibility and benefits for incoming patients (Medicaid, Medicare, and commercial payers) prior to intake.
• Review clinical documentation to ensure it supports medical necessity and submit authorization requests via payer portals or fax.
• Track and manage authorization status, including timely follow-ups on pending requests.
• Monitor expiring authorizations and coordinate renewals to prevent gaps in patient care (e.g., IOP or MAT services).
• Act as a point of contact for payer representatives to check status, clarify requirements, and resolve routine issues.
• Coordinate with clinicians to obtain required documentation or additional information for submissions and resubmissions.
• Collaborate with clinical, billing, and operations teams to ensure alignment across patient care and revenue cycle processes.
• Provide updates on authorization status to internal stakeholders as needed.
• Communicate with patients or families regarding insurance coverage, authorization status, and next steps in a clear, professional, and empathetic manner.
• Escalate authorization or coverage issues that may impact patient care.
• Coordinate with the billing team on cases that may require self-pay or alternative payment arrangements.
• Update the Electronic Health Records (EHR) to ensure accuracy across all patient authorizations and notes.

Denials, Documentation & Data Accuracy

• Assist in reviewing and addressing authorization-related denials, including supporting resubmissions when applicable.
• Identify documentation gaps and communicate feedback to clinicians to improve approval rates.
• Maintain accurate and up-to-date authorization records in the EHR, including authorization numbers, date ranges, and approved units.
• Track and document authorization outcomes (approved, denied, pending) to support visibility and reporting.

Payer Contracting & Rate Negotiation

• Assist in coordinating communications with insurance carriers related to contract updates or reimbursement terms.
• Support credentialing processes by preparing and organizing required documentation and tracking application status.

What You Should Have

Must-haves:

• At least 2 years of experience in prior Insurance Authorizations within Behavioral Health, General Healthcare, or SUD treatment.
• At least 1 year of experience working in a remote, global setup with a North America-based company.
• Strong experience verifying benefits, submitting authorizations, and managing follow-ups across commercial, Medicaid, and Medicare payers.
• Advanced proficiency with Electronic Health Records (EHR) & CRM systems (e.g., InSync, Behave Health, or similar platform).
• Proficiency with payer portals (e.g., Availity, Optum, Beacon/Carelon) and EHR systems.
• Solid understanding of HIPAA and healthcare data privacy requirements.
• Familiarity with Medicaid/MCO authorization workflows (Maryland experience preferred).
• Strong attention to detail and ability to manage high-volume authorization workflows with accuracy.
• Excellent communication skills, with the ability to interact professionally with payers, clinicians, and patients.
• Ability to manage multiple priorities, follow up persistently, and ensure timely resolution of authorization requests.

Technology Specifications:

• Minimum 100 Mbps Internet Speed
• Windows 11 or macOS 15 Sequoia
• Minimum Intel i5 8th gen with 8GB of RAM or Apple M1 chip with 8GB of RAM
• Webcam and Headset
• Designated Office Space in your Home

Nice-to-haves:

• Exposure to payer contracting, provider relations, or reimbursement discussions.
• Experience supporting contract-related processes such as credentialing or Single Case Agreements (SCAs).
• Basic understanding of reimbursement models (e.g., Fee-for-Service vs. Value-Based Care).
• Ability to review or support analysis of insurance contracts or carve-out structures.
• Active Medical Coding Certification (e.g., CPC or CCS-P).
• Clinical background or healthcare-related degree (e.g., nursing, pre-med, public health) is a plus.

Who You Are

We hope you are someone who:

• Persistent and solution-oriented when handling complex or delayed insurance authorizations.
• Communicates sensitive coverage outcomes with empathy, professionalism, and composure.
• Highly organized, resilient, and able to manage high volumes of administrative work while collaborating effectively across teams.