Authorization Specialist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking an Authorization Specialist to play a critical role in reviewing clinical documentation and medical records. The primary focus will be on Durable Medical Equipment (DME) authorizations. This role operates in a non-clinical capacity to ensure documentation completeness, accuracy, and alignment with payer requirements before the authorization submission. This position requires meticulous attention to detail, strong non-clinical record interpretation skills, and active communication with internal leadership and team members to ensure compliance and timely approval determinations.

Key Responsibilities

• Conduct detailed reviews of medical records, clinical notes, order documents, and claims history to determine if items meet established insurance medical necessity criteria.
• Compare submitted documentation against specific payer guidelines, internal quality standards, and standard operating procedures.
• Identify documentation gaps, inconsistencies, or missing clinical information, and communicate findings clearly to designated internal team members.
• Log review outcomes, case notes, and documentation status updates accurately into electronic case management tools and tracking systems.
• Prepare structured written summaries of review findings, citing specific missing elements or supporting clinical evidence.
• Submit medical prior authorization requests via payer portals, phone, or fax based on payer-specific guidelines.
• Track and follow up on submitted prior authorizations until a final approval or determination is rendered by the health plan.
• Maintain strict adherence to HIPAA guidelines, patient privacy standards, and company confidentiality policies.
• Follow defined escalation paths when complex clinical documentation requires supervisory input or advanced clarification.
• Meet or exceed defined daily productivity, accuracy, and quality metrics.
• Participate in calibration sessions, workflow training, and regular process updates regarding evolving payer rules and internal review protocols.
• Perform additional administrative support and order documentation tasks as assigned.

Qualifications

• High school diploma or GED equivalent required; Associate degree or healthcare-related coursework preferred.
• Minimum of three (3) years of experience reviewing and interpreting clinical records, medical documentation, insurance claims, or healthcare orders.
• Solid understanding of basic medical terminology and the ability to interpret patient charts, diagnoses, treatment plans, and clinical notes.
• Strong analytical skills and attention to detail to uncover documentation gaps and inconsistencies.
• Excellent written and verbal communication skills for summarizing findings and documenting case details.
• Proficiency in Microsoft Office applications (Excel, Word, Outlook) and the ability to quickly adapt to proprietary web portals and electronic case management systems.
• Proven ability to manage multi-task workflows effectively in a fast-paced environment while meeting productivity goals.
• Direct experience reviewing documentation for Durable Medical Equipment (DME), home health, specialty pharmacy, or prior authorizations is preferred.
• Previous experience submitting and tracking prior authorizations through insurance payer portals or electronic medical record (EMR) systems is preferred.
• Familiarity with commercial and government payer coverage guidelines, audit practices, and utilization review processes is preferred.

Skills

• Medical Documentation & Record Review: Analyzes and interprets clinical notes, medical records, and order documentation in a non-clinical capacity.
• DME & Payer Medical Necessity Guidelines: Consistently applies established payer criteria, medical necessity guidelines, and internal standard operating procedures to verify coverage eligibility.
• Quality Assurance & Verification: Identifies missing clinical notes, incomplete orders, or discrepancies in documentation with a high degree of precision.
• Written & Verbal Communication: Prepares clear, concise summaries of documentation findings and maintains effective communication regarding authorization statuses and missing items.
• Authorization Management & Compliance: Accurately submits prior authorization requests to insurance carriers and follows up systematically until a final coverage determination is rendered.
• Time Management & Productivity: Manages competing case priorities efficiently while meeting operational productivity targets, turnaround times, and quality standards.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.