Authorization Specialist

CommonSpirit Health • Woodland, CA

3d • Onsite

About The Position

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.

Requirements

• High School Diploma or GED
• General computer experience required
• Ability to read, write and speak English
• Ability to type a minimum of 35 words per minute
• Pass a clerical and ten key tests
• Pass 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
• Ability to communicate and interact effectively with internal and external customers
• Ability to work independently with minimum supervision, using time wisely
• Ability to take instruction and follow established procedures
• Ability to work under conditions that are every changing with frequent interruptions, and flexible hours
• Ability to maintain timely, accurate, legible, and complete records

Nice To Haves

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

Responsibilities

• Conduct comprehensive audits of financial records, processes, and regulatory compliance.
• Identify risks, evaluate internal controls, and provide insightful recommendations to enhance performance, mitigate fraud, and ensure adherence to healthcare laws.
• 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.
• Perform 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED