Find & Apply For Clinical Analyst / Clinical Documentation and Improvement Specialist Jobs in Cherry Hills Village, Colorado

DME Authorization Specialist Medix - 3.7 Cherry Hills Village, CO Job Details Contract $23.00 - $26.50 an hour 20 hours ago Qualifications Microsoft Excel Microsoft Outlook High school diploma or GED Documentation tools Medical terminology Documentation review Full Job Description The Order Documentation & Authorization Specialist plays a critical role in reviewing clinical documentation and medical records to evaluate whether submitted claims and orders meet specific insurance medical necessity guidelines, with a primary focus on Durable Medical Equipment (DME) authorizations. Operating in a non-clinical capacity, this role ensures documentation completeness, accuracy, and full alignment with payer requirements prior to authorization submission. The position requires meticulous attention to detail, strong non-clinical record interpretation, and active communication with internal leadership and team members to ensure compliance and timely approval determinations.

Key Responsibilities Documentation Review & Analysis Record Evaluation:

Conduct detailed reviews of medical records, clinical notes, and order documents to determine if items meet established insurance medical necessity criteria.

Compliance Verification:

Compare submitted documentation against specific payer guidelines, internal quality standards, and standard operating procedures.

Gap Identification:

Identify documentation gaps, inconsistencies, or missing clinical information, and communicate findings clearly to designated internal team members.

Authorization & Workflow Management Request Submission:

Submit medical prior authorization requests via payer portals, phone, or fax based on payer-specific guidelines.

Tracking & Follow-up:

Track and follow up on submitted prior authorizations until a final approval or determination is rendered by the health plan.

System Accuracy:

Log review outcomes, case notes, and documentation status updates accurately into electronic case management tools and tracking systems.

Quality & Compliance Regulatory Adherence:

Maintain strict adherence to HIPAA guidelines, patient privacy standards, and company confidentiality policies.

Escalation Pathways:

Follow defined escalation paths when complex clinical documentation requires supervisory input or advanced clarification.

Productivity Metrics:

Meet or exceed defined daily productivity, accuracy, and quality metrics as established by leadership. Required Skills High school diploma or GED equivalent (Associate degree preferred). 3+ years of experience reviewing and interpreting clinical records or healthcare orders. Solid understanding of medical terminology and ability to interpret patient charts and diagnoses. Strong analytical skills and attention to detail to uncover documentation gaps. Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and case management systems. Preferred Skills Direct experience with Durable Medical Equipment (DME) documentation review. Experience tracking prior authorizations through insurance payer portals or EMR systems. Familiarity with commercial and government payer coverage guidelines and audit practices.

For California Applicants:

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). This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. 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.