Referral Authorization Manager

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.
• 1-2 years of experience managing direct reports.
• Bilingual in Spanish (required).
• 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.

We are an Equal Opportunity Employer.