Prior Authorization Specialist

Order Documentation & Authorization Specialist Location: Denver, CO 80237 — Fully Onsite Pay: $23.00–$26.00/hour Schedule: Monday–Friday, 8:00 AM–5:00 PM Employment Type: Full-Time Position Overview We are seeking a detail-oriented Order Documentation & Authorization Specialist to support the review and processing of healthcare orders and insurance prior authorizations, with a primary focus on Durable Medical Equipment (DME) . This is a non-clinical role focused on reviewing medical records, clinical documentation, and order information to ensure cases meet established insurance medical necessity and documentation requirements before authorization requests are submitted. The ideal candidate will have strong healthcare documentation experience, excellent attention to detail, and the ability to interpret medical records while identifying missing or inconsistent information. Key Responsibilities Review medical records, clinical notes, physician orders, and claims history for completeness and accuracy. Compare documentation against payer-specific medical necessity guidelines, internal policies, and standard operating procedures. Identify missing documentation, inconsistencies, or discrepancies and communicate findings to the appropriate internal teams. Document review findings, case status, and follow-up activities accurately in electronic systems. Prepare clear, organized summaries outlining documentation gaps and supporting information. Submit prior authorization requests through insurance payer portals, phone, or fax. Track authorization requests and conduct timely follow-up until a final determination is received. Research payer requirements and ensure authorization submissions contain all required documentation. Escalate complex cases or documentation questions to leadership or appropriate internal resources. Maintain strict HIPAA compliance and protect patient confidentiality. Meet established productivity, accuracy, turnaround-time, and quality expectations. Participate in training, calibration sessions, and workflow updates as payer requirements evolve. Assist with additional administrative and order documentation projects as needed. Required Qualifications High school diploma or GED required. 3+ years of experience reviewing clinical records, medical documentation, insurance claims, or healthcare orders. Strong understanding of medical terminology and ability to interpret diagnoses, treatment plans, clinical notes, and physician documentation. Strong analytical and problem-solving skills. Exceptional attention to detail and ability to identify missing or inconsistent information. Excellent written and verbal communication skills. Proficiency with Microsoft Office, including Excel, Word, and Outlook. Ability to quickly learn electronic case management systems and insurance payer portals. Ability to manage multiple cases and competing priorities in a fast-paced environment. Ability to consistently meet productivity and quality expectations. Preferred Qualifications Experience with Durable Medical Equipment (DME) documentation or authorizations. Experience in home health, specialty pharmacy, medical equipment, or utilization review. Experience submitting and tracking authorizations through insurance payer portals or EMR systems. Familiarity with commercial insurance, Medicare, and Medicaid coverage guidelines. Experience interpreting payer medical necessity requirements. Previous experience with healthcare audits or documentation quality assurance. #J-18808-Ljbffr