Out of Network Authorization Specialist (ID# 5095)

The Out-of-Network Authorization Specialist is responsible for securing prior authorizations and verifying benefits for services rendered by providers who are not contracted with a patient's insurance plan. This role requires strong communication skills, attention to detail, and a deep understanding of payer policies to ensure accurate billing and minimize claim denials., * Initiate and follow up on prior authorization requests for out-of-network services.

• Verify patient insurance benefits and eligibility for out-of-network coverage.
• Communicate with insurance companies to determine coverage levels, out-of-pocket costs, and authorization requirements.
• Track and document authorization status in the EMR and billing systems.
• Work closely with billing and collections teams to resolve denied claims and appeals.
• Stay current with payer-specific guidelines and regulatory changes affecting out-of-network billing.
• Team player and accuracy are key.

• High school diploma or equivalent required; associate degree or certification in medical billing preferred.
• Minimum of 2-3 years of experience in medical billing, insurance verification, or prior authorization.
• Strong knowledge of commercial insurance plans, including PPO, POS, and indemnity plans.
• Familiarity with out-of-network billing practices and reimbursement models.
• Proficiency in EMR systems and billing software.
• Excellent communication, problem-solving, and organizational skills.