Pre-Authorization Specialist

University of Colorado

1d•Onsite

About The Position

The Orthotics Pre-Authorization Specialist is responsible for managing all aspects of Durable Medical Equipment (DME) precertification and preauthorization within the Department of Orthopedics. This role requires strong attention to detail, accuracy, follow-through, and independent problem-solving to ensure timely authorization approvals and successful patient care workflows. The specialist is expected to operate with accountability, urgency, and professionalism in a fast-paced clinical environment.

Requirements

Bachelor’s degree in healthcare administration, healthcare management, business administration, finance, biological science, nursing, human services, or related field
Equivalent combination of education and related experience may substitute year-for-year for the bachelor’s degree requirement.
One year of healthcare administration/insurance authorization experience.
A combination of education and related technical/military/paraprofessional experience may be substituted for a bachelor’s degree on a year for year basis.
Applicants must meet minimum qualifications at the time of hire.
Strong attention to detail and accuracy — able to prevent and correct errors proactively.
Demonstrated ability to independently prioritize workload and follow tasks through to completion.
Critical thinking and problem-solving skills; ability to resolve issues without re-direction.
Strong written and verbal communication skills.
Excellent customer service and patient-centered approach.
Ability to work effectively in a fast-paced environment and meet deadlines.
Ability to collaborate and build positive working relationships at all levels.
High degree of accountability, ownership, and reliability.
Organizational skills including queue management and tracking systems.
Ability to handle sensitive or emotionally charged situations professionally.
Empathy and advocacy for patients.

Nice To Haves

1-3 years in authorization or billing roles, preferably DME, rehabilitation, or orthopedic specialty.
Knowledge of medical coding, insurance rules, and medical terminology.
Experience working in EPIC or comparable EMR systems.

Responsibilities

Manage end-to-end authorization workflow for DME/orthotics/prosthetics, including initiation, document collection, insurer follow-up, and tracking through completion.
Submit authorizations through online portals and direct phone communication with payers.
Perform detailed benefits verification, including deductible/out-of-pocket amounts, coverage limitations, authorization requirements, and provider network status.
Proactively identify missing information, resolve issues, and prevent delays by partnering with providers, clinic teams, and external insurance representatives.
Track aging authorization requests and escalate barriers to prevent workflow disruption or financial loss.
Ensure timely and accurate documentation into EMR systems, including attaching required records and updating claim status.
Maintain ownership of work queue and authorization turnaround times, meeting defined productivity and accuracy expectations.
Review clinical documentation, match against ICD-10/CPT coding, and ensure accurate alignment to ordering provider documentation.
Demonstrate a continuous improvement mindset by identifying bottlenecks, suggesting solutions, and participating in process optimization efforts.
Maintain compliance with HIPAA, payer requirements, billing standards, and departmental guidelines.
Serve as a knowledgeable resource for patients, providers, schedulers, and clinic staff regarding authorization status and benefit questions.
Respond to calls and messages promptly to support a high-quality patient experience.
Collaborate with CU Medicine billing teams and assist with coordination between orthopedic providers and vendor partners.
Support onboarding and maintenance of vendor relationships and pricing structure.
Accept and process patient payments when applicable.
Support departmental quality improvement initiatives and organizational service standards.
Assist clinic operations and provider teams as necessary to support patient care and workflow efficiency.