Out of Network Authorization Specialist

Position Summary:

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.

Key Responsibilities:

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.

Qualifications:

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. We are an equal opportunity employer and comply with all applicable federal, state, and local fair employment practices laws. We strictly prohibit and do not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex, sexual orientation, gender (including gender identity and expression), marital or familial status, age, physical or mental disability, perceived disability, citizenship status, service in the uniformed services, genetic information, height, weight, or any other characteristic protected under applicable federal, state, or local law. Applications from members of minority groups and women are encouraged. #Acct