Authorization & Credentialing Manager

Authorization & Credentialing Manager


Location: Multi-site (8 Locations)

Schedule: Monday - Friday | 8:00 AM - 4:30 PM

Employment Type: Full-Time

About the Role


We are seeking an experienced Authorization & Credentialing Manager to oversee eligibility, prior authorizations, referrals, and credentialing operations across 8 locations supporting 11 physicians. This leader will manage a high-volume environment (approximately 150 authorizations per day) while ensuring regulatory compliance, operational efficiency, and strong team performance.


This is an excellent opportunity to join a growing healthcare organization with strong potential for career advancement.


Key Responsibilities


Leadership & Operations

• Oversee daily workflow of the Authorizations and Credentialing Department.
  
  
• Manage team productivity and performance across 8 locations.
  
  
• Plan, assign, monitor, and evaluate staff performance.
  
  
• Prevent backlog by proactively resolving workflow challenges.
  
  
• Establish clear departmental objectives and track performance metrics.
  
  
• Authorizations & Eligibility
  
  
• Ensure all patient eligibilities, referrals, and authorizations are obtained prior to appointments.
  
  
• Maintain up-to-date knowledge of insurance plans, authorization requirements, and medical necessity guidelines.
  
  
• Communicate directly with insurance carriers to stay current on policy updates.
  
  
• Maintain timeliness standards and ensure compliance with payer requirements.
  
  
• Credentialing
  
  
• Oversee provider credentialing and recredentialing processes.
  
  
• Maintain accurate and confidential credentialing databases.
  
  
• Ensure compliance with national accreditation standards and state/federal regulations.
  
  
• Verify provider licenses, certifications, and qualifications.
  
  
• Process Improvement
  
  
• Develop and maintain departmental policies and procedures.
  
  
• Collaborate with leadership to improve efficiencies and streamline workflows.
  
  
• Required Qualifications
  
  
• 3-10 years of leadership experience in a healthcare setting.
  
  
• Strong, in-depth knowledge of insurance authorization processes ("inside and out").
  
  
• Experience managing high-volume, multi-location operations.
  
  
• 3+ years of experience reviewing and interpreting payer contracts.
  
  
• Working knowledge of credentialing processes.
  
  
• Advanced understanding of insurance plans, Medicare, and Medicaid regulations.
  
  
• Experience with practice management systems and EHR software.
  
  
• Proficiency in Microsoft Office (Word, Outlook, Excel).
  
  
• Knowledge of medical terminology.
  
  
• Valid California Driver's License.
  
  
• High School Diploma or GED.
  
  
• Preferred Qualifications
  
  
• Medical Assistant Certification.
  
  
• 1+ year of demonstrated experience in a similar role.
  
  
• Soft Skills & Attributes
  
  
• Strong attention to detail.
  
  
• Ability to manage confidential provider information.
  
  
• Excellent interpersonal and customer service skills.
  
  
• Strong written and verbal communication skills.
  
  
• Ability to adapt and reorganize priorities in a fast-paced environment.
  
  
• Working Conditions
  
  
• Frequently moves items weighing up to 50 lbs.
  
  
• Prolonged periods of sitting and computer work.
  
  
• Must be able to move throughout office locations as needed.
  
  
• Required to wear personal protective equipment (e.g., KN95 masks).
  
  
• Overtime and occasional weekend work as needed.
  
  
• Review and interpret payer contracts.
  
  
• Ensure accurate handling of confidential provider information.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.