Authorization Specialist

Commonspirit-Health; Woodland (CA); On-site; USD 55,000 - 85,000; Full time

Job summary

Dignity Health Medical Foundation seeks an Authorization Specialist to protect compliance and financial integrity across the facility. You will audit financial records and internal controls, identify risks, and provide actionable recommendations to improve performance while ensuring adherence to healthcare laws.

The role requires strong analytical skills, attention to detail, and the ability to clearly communicate findings to diverse stakeholders.

Qualifications

• Audits financial records, processes and regulatory compliance.
• Identify risks and evaluate internal controls to enhance performance.
• Communicate complex findings persuasively to drive improvements.

Responsibilities

• Keep accurate records in EMR/practice management systems and manual filings.
• Obtain internal and external prior authorizations for insurance carriers and schedule patient appointments.
• Interface with provider office staff to obtain information for authorization approval.
• Screen for Advanced Beneficiary Notice as needed for services referred to other departments.
• Collaborate with billing staff to maximize reimbursement through appeals.

Skills

Auditing

Healthcare regulations

Communication

Attention to detail

Independent work

Education

High School Diploma or GED

Tools

EMR system

Practice management system

Windows OS

Job description

Job Summary and Responsibilities

As our Authorization Specialist, you will be a critical guardian of compliance and financial integrity, optimizing operational efficiency across our facility.

Every day, you will conduct comprehensive audits of financial records, processes, and regulatory compliance. You’ll identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws, directly supporting sound decision-making.

To be successful in this role, you will combine strong analytical and investigative skills with an in-depth understanding of healthcare regulations, sharp attention to detail, and the ability to communicate complex findings persuasively, transforming audit insights into tangible improvements.

This is an SEIU represented role.

• Keep accurate records in the EMR and/or practice management system as well as any manual filing systems.
• Obtain internal and external prior authorizations for all insurance carriers using carrier specific tools and/or methods and schedule patient appointments communicating with patient and provider/nursing staff as necessary.
• Interface with provider office staff for the purpose of attaining additional information required for authorization approval.
• Advanced Beneficiary Notice Screening as necessary for services referred to other departments such as cardio‑pulmonary lab, radiology, gastroenterology, etc.
• Collaborate with billing staff to maximize reimbursement through claims appeals.
• Update patient demographics and/or insurance as needed.

Job Requirements

Required

• High School Diploma or GED
• General computer experience required
• Has the ability to read, write and speak English in order to perform duties of the position, as well as the ability to type a minimum of 35 words per minute, pass a clerical and ten key tests as well as a pre‑employment aptitude test
• Fundamentals of business communications, Windows based computer operating system
• Ability to: Apply good judgement in a variety of confidential and sensitive situations
• Required knowledge of a variety of insurance carrier protocols as demonstrated through successful completion of the aptitude test
• Communicate and interact effectively with internal and external customers
• Work independently with minimum supervision, using time wisely
• Take instruction and follow established proceduresWork under conditions that are every changing with frequent interruptions, and flexible hours
• Maintain timely, accurate, legible, and complete records

Preferred

• At least one-year recent experience in a medical office practice, including business and scheduling functions
• Knowledge of Medical terminology

Where You'll Work

Dignity Health Medical Foundation established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California , Arizona and Nevada. Today Dignity Health Medical Foundation works hand‑in‑hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers we provide increasing support and investment in the latest technologies finest physicians and state‑of‑the‑art medical facilities. We strive to create purposeful work settings where staff can provide great care while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well‑trained and highly skilled qualities that are vital to maintaining excellence in care and service.

One Community. One Mission. One California