Healthcare Authorization & Compliance Analyst

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

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