Authorization Specialist II: Denials & Approvals

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

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