Authorization Coordinator II

Wilmington Community Clinic; California (MO); On-site; USD 32,000 - 37,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

10 vacation days first year

12 paid holidays

Sick leave

Life insurance

Retirement plan

Employee assistance program

Job summary

Wilmington Community Clinic in Los Angeles seeks an Authorization Coordinator II to manage complex prior authorization requests, resolve payer issues, and support efficient reimbursement workflows. You will serve as a subject matter expert in payer requirements, coordinate referrals, train staff, and drive process improvements while maintaining accurate EHR documentation.

This role emphasizes timely submissions, denial resolution, and collaboration with providers to ensure continuity of care and

Qualifications

• High school diploma or equivalent is required.
• Minimum 3–4 years of experience in authorizations, referrals, or care coordination.
• Prior experience in an FQHC or similar setting strongly preferred.

Responsibilities

• Process and oversee complex prior authorization requests, including high-cost procedures, specialty services, and out-of-network referrals.
• Investigate and resolve authorization denials, including preparation of appeals, coordination of peer-to-peer reviews, and resubmissions.
• Serve as primary point of contact for payer-related issues, including Medi-Cal managed care plans and specialty programs.
• Monitor authorization work queues and identify delays, trends, or workflow gaps; take action to ensure timely resolution.
• Meet established turnaround times for authorization submission and follow-up.
• Ensure timely follow-up on all pending authorizations and support “closing the loop” on approved services.
• Collaborate with providers to obtain necessary clinical documentation to support authorization approvals.
• Coordinate with referral staff and external specialists to ensure continuity of care and timely service delivery.
• Train and mentor Authorization Coordinator I staff; provide guidance on workflows, payer requirements, and issue resolution.
• Assist in development and refinement of authorization workflows, policies, and tracking tools.
• Partner with Quality Improvement (QI) and leadership teams to monitor performance metrics and improve access to care.
• Maintain accurate and complete documentation in the EHR and tracking systems.
• Ensure compliance with all regulatory, payer, and organizational requirements.

Skills

Prior authorization

Payer requirements

Denial management

Epic experience

Communication skills

Bilingual Spanish

Education

High school diploma or equivalent

Tools

Epic EHR

Job description

Join Wilmington Community Clinic!

Have you ever wanted to be a part of something bigger? Have you ever wanted to make a difference? At Wilmington Community Clinic, here you can. WCC provides quality, non-discriminatory primary care, mental health, dental and women’s health services to improve the health and well-being of all served – regardless of their ability to pay. We have served patients in and around Wilmington and Los Angeles for over 40 years. Our multi-generational impact makes us proud of the services we provide, and we put patient care front and center - it's The Wilmington Way!

Position Summary

The Authorization Coordinator II is responsible for managing complex authorization requests, resolving payer-related issues, and supporting the overall efficiency and integrity of the authorization process. This role serves as a subject matter expert in payer requirements, prior authorization workflows, and referral coordination. The Authorization Coordinator II works independently to resolve denials, reduce delays, and ensure continuity of care, while supporting team training and process improvement initiatives.

Compensation and Benefits

The compensation for this position is $23.00 - $27.00 hourly.

WCC offers competitive salary and benefits including medical, dental and vision health insurance plans, 10 vacation days for first year employees, 12 paid holidays, sick leave, life insurance, a retirement plan, and an employee assistance program.

Education and Experience

• High school diploma or equivalent education required
• Minimum 3–4 years of experience in authorizations, referrals, or care coordinationrequired
• Prior experience in an FQHC or similar setting strongly preferred

Essential Position Responsibilities

• Process and oversee complex prior authorization requests, including high-cost procedures, specialty services, and out-of-network referrals
• Investigate and resolve authorization denials, including preparation of appeals, coordination of peer-to-peer reviews, and resubmissions
• Serve as primary point of contact for payer-related issues, including Medi-Cal managed care plans and specialty programs
• Monitor authorization work queues and identifydelays, trends, or workflow gaps; take action to ensure timelyresolution
• Meet established turnaround times for authorization submission and follow-up
• Ensure timelyfollow-up on all pending authorizations and support “closing the loop” on approved services
• Collaborate with providers to obtain necessary clinical documentation to support authorization approvals
• Coordinate with referral staff and external specialists to ensure continuity of care and timelyservice delivery
• Support eConsult workflows and specialty programs (e.g., Every Woman Counts) as applicable
• Train and mentor Authorization Coordinator I staff; provide guidance on workflows,payer requirements, and issue resolution
• Assistin development and refinement of authorization workflows, policies, and tracking tools
• Partner with Quality Improvement (QI) and leadership teams tomonitorperformance metrics and improve access to care
• Maintainaccurateand complete documentation in the EHR and tracking systems
• Ensure compliance with all regulatory, payer, and organizational requirements
• Participate in meetings, audits, and performance improvement initiatives
• Perform other duties as assignedin support of WCC’s mission.

Skills

• Strong knowledge of prior authorization processes, payer requirements, and denial management
• Experience with Medi-Cal managed care, specialty networks, and public health programs strongly preferred
• Advanced problem-solving and critical thinking skills
• Ability to manage complex, high-volume workflows independently
• Strong communicationand interpersonal skills
• Proficiencywith EHR systems and reporting tools (Epic preferred)
• Ability to train and support staff
• BilingualEnglish/Spanishpreferred.