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.
We are an Equal Opportunity Employer.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.
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