Prior Authorization & Referral Manager

Manage and train, evaluate direct reports
Manage staff schedules and approve time and attendance
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
Ensure medical documentation meets the billing and approval standards of insurance carriers.
Ensure regulatory compliance with required submission timelines
Adhere to company policy and procedures

4 years of progressive experience processing referrals and pre-authorizations in a medical administration or referral coordination role.

• 1-2 years of experience managing direct reports.
• Bilingual in Spanish (required).
• Advance knowledge with medical terminology, IPA processes, and ICD, CPT codes
• Highschool graduate or higher education
• 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.

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.\