Pre-Authorization Representative

About the role

Insurance Authorization Representative

This role exists to ensure patients are financially and clinically cleared for care by managing insurance authorization, pre-certification, and registration processes that enable timely diagnostic services. Within the patient access and revenue cycle at SimonMed Imaging, this position serves as a critical checkpoint. The representative ensures diagnostic exams receive proper authorization, financial review, and compliant scheduling in alignment with insurance requirements and organizational standards. This is a detail-driven, patient-facing administrative function where accuracy, communication, and insurance knowledge directly shape patient experience and operational efficiency. Individuals who enjoy navigating healthcare systems and removing barriers to care will find daily purpose in this role.

Location

3915 E. Colonial Dr. Orlando, FL 32803

Engagement

Full-Time

Compensation

The annual compensation range is established between twenty-one and fifty cents and twenty-three and fifty cents per hour for the 2024 cycle.

Key Responsibilities

Confirming patient details and insurance scope serves as the initial step before scheduling intake appointments for imaging services. This verification work establishes the foundation for a compliant appointment.

Cross-checking coverage rules and benefits forms the basis for pre-certifying exams. Each authorization must reflect medical necessity and adhere to payer policy criteria without exception.

Updating registration records requires exact alignment of personal data, referrals, and prior authorization codes with payer specifications. This diligence prevents downstream processing failures.

Coordinating with providers and payers is necessary to resolve authorization gaps. Such collaboration keeps appointment timelines intact and prevents unnecessary delays in service delivery.

Communicating cost and timing details to patients ensures financial expectations are transparent before visit day. Clear explanations reduce confusion and support informed decision-making.

Reviewing documentation completeness confirms that claims can advance without rework or delay. Every checklist must be satisfied to meet compliance and billing accuracy standards.

Shipping finalized schedules and authorization results to operations guarantees that diagnostic services can start on time. This handoff connects administrative work to clinical care.

Partnering with internal teams helps align workflows, close procedural gaps, and uphold cycle time and compliance standards. Continuous improvement depends on this cooperative approach.

Performing eligibility checks and benefit verification to confirm coverage status before the patient arrives for service. This step prevents access issues and supports a smooth patient flow.

Entering prior authorization requests into the system with precise attention to timelines and required documentation. Accurate submissions reduce the risk of denials and rescheduled appointments.

Maintaining organized records of all authorization activities and documenting interactions in accordance with compliance guidelines. This practice supports audits and operational reviews.

Following up on pending authorizations to ensure timely responses from payers and to keep the scheduling pipeline efficient. Proactive tracking minimizes bottlenecks in service delivery.

Assisting patients in understanding financial obligations, co-pays, and deductibles related to their imaging services. Transparent communication fosters trust and reduces billing surprises.

Supporting the operational team by providing status updates on authorizations and helping to manage workflow priorities during peak periods. This contribution maintains overall department efficiency.

Contributing to quality assurance initiatives by identifying patterns in denials or delays and suggesting corrective actions to improve the pre-authorization process.

Requirements

Current experience in insurance authorization and pre-certification for diagnostic imaging is mandatory. Candidates must demonstrate a track record in these specific areas.

The ability to manage appointment scheduling while balancing payer policies and patient needs with precision defines successful performance. This balance requires constant attention to detail.

Accurate entry of registration data is essential. Maintaining records that satisfy both compliance and billing accuracy is a daily expectation of the role.

Clear communication with providers, payers, and patients is required to resolve questions and prevent access delays. Professional dialogue skills are non-negotiable.

Meeting the listed compensation band for 2024 is a condition of employment. The range spans twenty-one and fifty cents to twenty-three and fifty cents on the dollar annually.

Three years of focused experience in prior authorization, pre-certification, or related intake work is required. This experience must be verifiable and directly relevant.

Nice to have

Experience within multi-payer environments and imaging center operations adds value but is not mandatory. Exposure to diverse payer structures can enhance role effectiveness.

Practical notes

All information presented here reflects current expectations and operational requirements.