Referral Authorization Manager

Job Description

Job Description

Essential Duties and Responsibilities: 

• Manage and train, evaluate direct reports 
• Manage staff schedules and approve time and attendance 
• Provide necessary and routine reports  
• Streamline existing referral processes and protocols, and standard operating procedures across clinics.  
• Monitor daily referral & prior authorization turnaround time and conversion rates to identify operational obstacles, providing resolutions.  
• Review and analysis for all referral/authorizations submitted by the health centers timely and accurately  
• Communicate with providers, clinical, and non-clinical support staff 
• Ensure medical documentation meets the billing and approval standards of insurance carriers. 
• Ensure regulatory compliance with required submission timelines 
• Proficient written and verbal communication 
• Adhere to company policy and procedures 

Qualifications: 

• 4 years of progressive experience processing referrals and pre-authorizations in a medical administration or referral coordination role.  
• Advance knowledge with medical terminology, IPA processes, and ICD, CPT codes 
• Experience working in a professional setting, healthcare related and/or supervisory experience, FQHC experience preferred 
• Experience with ECW and E-Consult 
• Highschool graduate or higher education  
• Ability to work with population or diverse cultural, educational, social, and economic backgrounds 

T.H.E. Health and Wellness Centers is a nonprofit community clinic in South Los Angeles. For more than 50 years, we've provided high-quality, low cost healthcare and preventative education for all.

Company Description

T.H.E. Health and Wellness Centers is a nonprofit community clinic in South Los Angeles. For more than 50 years, we've provided high-quality, low cost healthcare and preventative education for all.\r\n\r\nWe are an Equal Opportunity Employer.