Authorization Specialist

Woodland Clinic Medical Group; Woodland (CA); On-site; USD 46,000 - 58,000; Full time

Job summary

Woodland Clinic Medical Group is seeking an Authorization Specialist to safeguard compliance and financial integrity across our facility in California. You will audit financial records, assess risks, and recommend improvements to ensure adherence to healthcare laws and optimized decision-making.

You will maintain accurate EMR/PM records, obtain prior authorizations, interact with provider staff, screen for ABN when needed, support claims appeals with billing, and keep patient demographics up to

Qualifications

• High School Diploma or GED required.
• General computer experience required.
• English reading/writing/speaking; typing 35 wpm; clerical/ten-key aptitude tests.
• Fundamentals of business communications; Windows OS.
• Ability to exercise good judgement in confidential/sensitive situations.
• Knowledge of insurance carrier protocols demonstrated by aptitude test.
• Effective communication with internal/external customers.
• Ability to work independently with minimal supervision and manage time.
• Follow established procedures; adapt to changing conditions and interruptions.
• Maintain timely, accurate, legible, complete records.

Responsibilities

• Audit financial records, processes and regulatory compliance to identify risks and improve performance.
• Identify risks, evaluate internal controls and provide recommendations to enhance performance and mitigate fraud.
• Communicate complex findings and transform audit insights into improvements.
• Keep accurate records in the EMR and/or practice management system and any manual filing.
• Obtain internal and external prior authorizations for all insurance carriers and coordinate with patients and staff.
• Interface with provider office staff to obtain information needed for authorization approval.
• Perform Advanced Beneficiary Notice screening for services referred to other departments.
• Collaborate with billing staff to maximize reimbursement through claims appeals.
• Update patient demographics and insurance information as needed.

Skills

Auditing

Analytical thinking

Regulatory compliance

Communication

Attention to detail

Time management

Education

High School Diploma or GED

Tools

EMR software

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