Pre-Authorization Specialist

Pre-Authorization Specialist

University of Colorado Colorado Springs – School of Medicine - Orthopedics – Position #:  – Requisition #: 38778

Strong attention to detail, accuracy, follow‑through, and independent problem‑solving. Responsible for managing all aspects of Durable Medical Equipment (DME) precertification and pre‑authorization within the Orthopedics Department, ensuring timely authorization approvals and supporting patient care workflows in a fast‑paced clinical environment.

• Authorization & Insurance Workflow – 75%
  • Manage end‑to‑end authorization workflow for DME/orthotics/prosthetics, including initiation, document collection, insurer follow‑up, and completion tracking.
  • 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 elevate barriers to prevent workflow disruption or financial loss.
  • Ensure timely and accurate documentation into EMR systems, including attaching required records and updating claim status.
• Operational Excellence & Accountability – 10%
  • 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.
  • Identify bottlenecks, suggest improvements, and participate in process optimization.
  • Maintain compliance with HIPAA, payer requirements, billing standards, and departmental guidelines.
• Customer, Clinic, and Vendor Support – 10%
  • 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 high‑quality patient experience.
  • Collaborate with CU Medicine billing teams and coordinate between orthopedic providers and vendor partners.
  • Support onboarding and maintenance of vendor relationships and pricing structure.
• Additional Responsibilities – 5%
  • Accept and process patient payments when applicable.
  • Support departmental quality improvement initiatives and organizational service standards.
  • Assist clinic operations and provider teams to support patient care and workflow efficiency.

Onsite – Steadman Hawkins Inverness Clinic, Englewood, CO. May involve work at other CU affiliated health clinics within the Denver Metropolitan area or CU Anschutz Medical Campus, Aurora, CO.

• Medical:
  Multiple plan options
• Dental:
  Multiple plan options
• Additional Insurance:
  Disability, Life, Vision
• Retirement 401(a) Plan:
  Employer contributes 10% of your gross pay
• Paid Time Off:
  Accruals over the year
• Vacation Days: 22 per year (max 352 hours)
• Sick Days: 15 per year (unlimited max accrual)
• Holiday Days: 15 per year
• Tuition Benefit:
  Available on all CU campuses
• ECO Pass:
  Reduced rate RTD Bus and light rail service

• Minimum Qualifications
  • 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.
• Preferred Qualifications
  • 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.

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…