Out-of-Network Authorization Specialist

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 gui...