Authorization and Integration Specialist

Jobtailor; Garden Grove (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor is seeking a healthcare Revenue Cycle specialist to lead and optimize insurance authorization workflows in California, ensuring timely payer authorizations and reducing denials. You will collaborate with payers and internal teams to scale processes, monitor performance, and implement policy changes across EHR and practice management systems.

Strong communication and project leadership are essential.

Qualifications

• High school diploma or GED required.
• 5+ years of experience in healthcare revenue cycle, insurance authorizations, medical billing, or related operations.
• Experience with insurance authorization processes and payer requirements.
• Experience with EHR, practice management, and/or medical billing systems.
• Understanding of reimbursement processes and link between authorizations, claims, and denials.
• Experience developing or improving healthcare workflows and processes.
• Proficient with computers, email, virtual platforms, and MS Office.
• Preferred: Medi-Cal, CalAIM programs, and eCW experience.

Responsibilities

• Support development, implementation, and integration of authorization workflows within Revenue Cycle.
• Manage complex authorization processes and ensure services are authorized within payer timeframes.
• Monitor authorization workflows, work queues, turnaround times, and expiring authorizations.
• Interpret payer requirements and incorporate into workflows.
• Resolve missing or expiring authorizations with operational teams.
• Identify issues contributing to denials and revenue loss; collaborate to resolve.
• Develop processes to reduce denials and prevent revenue loss.
• Support integration of authorization functions into Revenue Cycle, including documentation and policies.
• Lead and coordinate complex authorization projects, timelines, and deliverables.
• Analyze processes and performance trends to improve efficiency and reimbursement.
• Coordinate with Revenue Cycle, Finance, Data, and leadership to resolve issues.
• Oversee processing of Community Supports housing-related deposits and timely documentation.
• Communicate process changes and payer requirements to stakeholders.

Skills

Insurance authorization processes

Payer requirements

Workflow improvement

Project management

Data analysis

Communication skills

Attention to detail

Organizational skills

Problem solving

Education

Associate or bachelor's degree in healthcare administration, business administration, finance, or related field

Tools

Electronic Health Record (EHR)

Practice Management Systems

Microsoft Office

EClinicalWorks (eCW)

Virtual Platforms

Job description

• Support the development, implementation, and integration of authorization workflows within Revenue Cycle
• Manage complex authorization processes and ensure services are authorized within payer-required timeframes
• Monitor authorization workflows, work queues, turnaround times, missing or expiring authorizations, and outstanding requests
• Research and interpret payer authorization requirements and incorporate them into workflows
• Resolve missing, incomplete, or expiring authorizations with operational teams
• Identify authorization issues contributing to claim denials, delayed reimbursement, and revenue loss
• Collaborate with payers, Revenue Cycle, and operational teams to resolve complex authorization barriers
• Develop processes to reduce authorization-related denials and prevent avoidable revenue loss
• Support integration of authorization functions into Revenue Cycle, including workflows, documentation, controls, and cross-functional processes
• Support authorization processes for new payers, contracts, programs, services, and changing payer requirements
• Serve as a subject matter resource for authorization processes, workflows, and payer requirements
• Lead and coordinate complex authorization and Revenue Cycle projects, workflow implementations, payer initiatives, process improvements, and system enhancements
• Develop project plans, coordinate stakeholders, monitor timelines and deliverables, identify barriers, and drive projects to completion
• Analyze authorization processes, operational data, and performance trends to improve efficiency, accuracy, reimbursement, and financial performance
• Develop and implement workflow improvements and Revenue Cycle policies, procedures, workflows, and process standards
• Partner with Revenue Cycle, Finance, Data, and operational leadership to resolve complex issues
• Oversee processing and tracking of Community Supports housing-related deposits
• Ensure housing deposit requests are complete, accurately documented, and processed timely
• Monitor unresolved housing deposit items and coordinate follow-up through resolution
• Support consistent authorization processes with the Authorization & Denial Specialist and Revenue Cycle team
• Develop resources, documentation, and training materials
• Communicate process changes, payer requirements, and identified issues to stakeholders
• Perform other assigned duties and projects

Requirements

• High school diploma or GED required
• Minimum of 5 years of experience in healthcare revenue cycle, insurance authorizations, medical billing, reimbursement, practice management, or related healthcare operations
• Demonstrated experience with insurance authorization processes and payer requirements
• Experience with electronic health record (EHR), practice management, and/or medical billing systems
• Working knowledge of healthcare reimbursement processes and the relationship between authorizations, claims, denials, and reimbursement
• Experience developing, implementing, or improving healthcare operational workflows and processes
• Distraction-free home workspace with a secure internet connection
• Fluent in English, written and verbal
• Ability to communicate clearly in-person, by phone, and electronically
• Adequate hearing and vision, with corrective devices if necessary
• Ability to identify problems and use logic and related information to develop and implement solutions
• Excellent organizational skills and attention to detail
• Commitment to maintaining patient confidentiality and adhering to ethical standards in healthcare practice
• Must be able to remain in a stationary position
• Must be able to move around the office and/or travel throughout the community
• Ability to operate a vehicle and travel to meet with members around the community; attend meetings and events as required or requested
• Frequent use of computers, keyboard, and handheld/mobile devices
• Ability to type for extended periods
• Competent with computers, email, virtual platforms, and Microsoft Office-based programs
• Associate or bachelor's degree in healthcare administration, business administration, finance, or related field preferred
• Experience with Medi-Cal managed care and payer requirements preferred
• Experience supporting CalAIM programs, including Enhanced Care Management (ECM) and Community Supports (CS) preferred
• Experience with authorization-related denials and denial prevention preferred
• Experience integrating or centralizing authorization functions within a healthcare organization preferred
• Experience leading cross-functional projects or Revenue Cycle process improvement initiatives preferred
• Experience with eClinicalWorks (eCW) preferred

Core Competencies

Demonstrates expertise in healthcare revenue cycle management, particularly in insurance authorization processes and payer requirements. Proven ability to develop and implement workflow improvements, analyze operational data, and lead cross-functional projects to enhance efficiency and financial performance.

Highest-signal resume keywords

• Healthcare Revenue Cycle Management
• Insurance Authorization Processes
• Workflow Improvement
• Project Management
• EHR Systems

ATS Optimization Keywords

Hard Skills

• Medical Billing
• Reimbursement Processes
• Payer Requirements
• Operational Workflows
• Authorization Processes
• Denial Prevention
• Data Analysis
• Performance Trends
• Community Supports
• CalAIM Programs

Soft Skills

• Communication Skills
• Organizational Skills
• Problem-Solving
• Attention to Detail
• Collaboration

Industry Keywords

• Healthcare Operations
• Authorization Workflows
• Claim Denials
• Revenue Loss
• Patient Confidentiality

Tools & Technologies

• Electronic Health Record (EHR)
• Practice Management Systems
• Microsoft Office
• EClinicalWorks (eCW)
• Virtual Platforms