Authorization Appeal Specialist

Job Title

Authorization Appeal Specialist

Job Description

Authorization Appeal Specialist (Plymouth, MN)

The Authorization Appeal Specialist is responsible for managing the appeal process for denied authorizations of durable medical equipment while maintaining strong communication with patients and healthcare teams. This role ensures patients remain informed, supported, and engaged throughout the authorization and appeals process. The specialist works closely with territory managers, physicians, clinical staff, and insurance payers to gather required documentation, resolve issues, and advocate for medically necessary services. Success in this role requires excellent communication skills, a solid understanding of insurance policies and medical terminology, and a commitment to patient-centered service.

Your role:

• Review denied authorizations, identify denial reasons, and develop effective appeal strategies by researching payer policies and guidelines. Gather and organize complete supporting documentation while ensuring all appeal activities meet required deadlines.
• Clearly explain denial reasons, next steps, and appeal expectations to patients while providing timely updates on status and documentation needs. Address questions with empathy and professionalism, documenting all interactions and ensuring follow-up actions are completed.
• Partner with healthcare teams, Territory Managers, and clinical advocates to obtain necessary documentation and resolve delays. Communicate clinical requirements, share appeal progress, and ensure alignment to support continuity of care.
• Maintain accurate and organized records of appeal activities, patient communications, and documentation requests. Track outcomes to identify trends and ensure full compliance with HIPAA and confidentiality standards.
• Stay up to date on insurance policies, authorization requirements, and industry changes that impact appeals. Educate internal teams on payer expectations and best practices to improve appeal success rates.
• Participate in team meetings, cross-training, and required training sessions, including HIPAA compliance. Adhere to all company policies, procedures, and applicable regulations in daily work.

You're the right fit if:

• You’ve acquired 2+ years of experience in Customer Service, preferably in the healthcare industry or equivalent.
• You have demonstrated superior customer service skills, strong analytical and problem-solving capabilities, the ability to organize and prioritize workload, and strong computer skills—including word processing and spreadsheet software.
• You have a High School Diploma, Vocational Education, or equivalent.
• You must be able to successfully perform the following minimum Physical, Cognitive and Environmental job requirements with or without accommodation for this position.
• You have strong interpersonal skills, excellent communication skills - both verbal and written- and have the ability to work well independently and as a part of a team.

How we work together

We believe that we are better together than apart. For our office-based teams, this means working in-person at least 3 days per week. Onsite roles require full-time presence in the company’s facilities. Field roles are most effectively done outside of the company’s main facilities, generally at the customers’ or suppliers’ locations.

This is an office role.

About Philips

We are a health technology company. We built our entire company around the belief that every human matters, and we won't stop until everybody everywhere has access to the quality healthcare that we all deserve. Do the work of your life to help improve the lives of others.

• Learn more about our business.
• Discover our rich and exciting history.
• Learn more about our purpose.
• Learn more about our culture.

Philips Transparency Details

The pay range for this position in MN is $24.00 - $36.00 per hour.

The actual base pay offered may vary within the posted ranges depending on multiple factors including job-related knowledge/skills, experience, business needs, geographical location, and internal equity.   

In addition, other compensation, such as an annual incentive bonus, sales commission or long-term incentives may be offered.  Employees are eligible to participate in our comprehensive Philips Total Rewards benefits program, which includes a generous PTO, 401k (up to 7% match), HSA (with company contribution), stock purchase plan, education reimbursement and much more.  Details about our benefits can be found here. 

At Philips, it is not typical for an individual to be hired at or near the top end of the range for their role and compensation decisions are dependent upon the facts and circumstances of each case. 

Additional Information

US work authorization is a precondition of employment. The company will not consider candidates who require sponsorship for a work-authorized visa, now or in the future.

Company relocation benefits will not be provided for this position.  For this position, you must reside in or within commuting distance to Plymouth, MN.

This requisition is expected to stay active for 45 days but may close earlier if a successful candidate is selected or business necessity dictates.  Interested candidates are encouraged to apply as soon as possible to ensure consideration.

Philips is an Equal Employment and Opportunity Employer including Disability/Vets and maintains a drug-free workplace.