Authorization Representative

Since 1980, SMIL has evolved into the premier imaging provider in the southwest. SMIL won the 2016 Southwest Alliance for Excellence award for customer and employee satisfaction, sound management, innovation and results. SMIL was again recognized with the prestigious Advisory Board Company's 2017 Workplace of the Year Award, and in 2019 SMIL was named a World Class Employer by Birdeye Surveys, Inc.

Employee engagement is part of everything we do at SMIL. We are dedicated to the growth of our employees including cross training and leadership career opportunities. Simply put, our culture is what sets us apart from the rest.

We offer competitive pay, career opportunities and benefits that include; medical, HSA employer contribution, dental, vision, paid time off, paid holidays, 401K and company paid profit sharing, tuition and continuing education reimbursement, paid life insurance, paid long term disability as well as voluntary short term disability.

We look forward to having you join our amazing team!

Position Summary

The Authorization Representative's primary responsibility will be to verify patient eligibility, determine radiology benefits and to obtain insurance pre-authorization prior to the patient's exam date and time. The Authorization Representative will work in a corroborative, team environment by establishing strong working relationships with Payors, patients, referring physicians, business office, and imaging center staff. The Authorization Representative must also display strong detailed oriented skills with the proven ability to multitask; handling multiple patient pre-authorization requests at a time. Medical terminology will be used daily. Knowledge of Radiology exams is needed. The Authorization position and job function is a value-added service offering to SMIL's referring physicians and will require a commitment to "World Class Customer Service".

Detailed Responsibilities

• Uses real time work list to prioritize workload in obtaining patient authorization prior to the scheduled exam date and time.
• Responsible for verification of patient insurance eligibility.
• Determine individual insurance plan radiology benefits for scheduled exams.
• Obtain clinical history from referring physician in order to obtain authorization on a scheduled exam.
• Adheres to Documentation Guidelines pertaining to status of patient benefits and/or authorization.
• All eligibility, authorization, and determination of benefits information obtained are to be documented appropriately in the patient's medical record in Fuji RIS.
• Upon completion of the eligibility and authorization process, complete the Authorization Task/tasks.
• Communicate with patients and/or referring physicians on non-covered benefits or exam coverage issues.
• Adheres to all HIPAA Guidelines.
• Provide assistance to Imaging Center Staff, Scheduling Staff, and Assessment Coordinator Departments regarding Authorization and Eligibility.
• Stay informed; communicate any updates and/or changes in Payor authorization requirements.
• Inform Contact Center Coordinators and Department Management of potential problem cases to receive direction on how to resolve situations.
• Responsible for addressing prior exams on worklist.
• Participate in Team and Payor meetings.
• Attends scheduled up-training courses as needed on new and revised SMIL Authorization processes and changes in workflow.
• Answers incoming calls in Authorization queue.
• Performs other related duties as assigned or requested.

Education and Experience

• High School Diploma or Equivalent
• At least 1 year of medical experience is required
• 1-2 years experience in Insurance Eligibility and Authorization Process preferred
• Radiology/Medical Industry related Certification is a plus, but not required

Physical Requirements

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk and hear. The employee is frequently required to sit. Specific vision abilities required by this job include close vision, color vision, ability to adjust focus.