Pre-Authorization Specialist

Job Title

Pre-Authorization Specialist

Orthopedics, University of Colorado Anschutz Medical Campus

The Orthotics Pre-Authorization Specialist is responsible for managing all aspects of orthotics 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.

Authorization & Insurance Workflow – 75%

• Manage end‑to‑end authorization workflow for DME/orthotics, 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 escape 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.
• 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.

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 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.

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 as necessary to support patient care and workflow efficiency.

Onsite – this role is expected to work onsite at clinics within the Denver Metropolitan Area, including the Steadman Hawkins Inverness clinic in Englewood and the Foot and Ankle Center at Central Park.

The University of Colorado, Department of Orthopedics is a recognized global leader in the field and Colorado's most trusted orthopedic group for adults and children. Our unique position at the forefront of medical science, education, and practice innovation translates in real‑time to the most advanced patient care, unmatched in Colorado and the Rocky Mountain Region. From routine cases to the most complex, we treat every orthopedic condition including injuries and diseases of the bones, joints, nerves, tendons, ligaments, and muscles across many orthopedic specialties.

Benefits

• 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/year (maximum accrual 352 hours)
• Sick Days: 15/year (unlimited maximum accrual)
• Holiday Days: 10/year
• Tuition Benefit:
  Employees have access to this benefit on all CU campuses
• ECO Pass:
  Reduced rate RTD Bus and light rail service

Minimum Qualifications

• Bachelor's degree in biological science, nutrition, nursing, health, human services, psychology,…