POSITION: REFERRAL AUTHORIZATION MANAGER

DEPARTMENT: Medical Unit

STATUS: Full-Time, Exempt

POSITION SUMMARY:

Under the direction of the Director of Patient Services, this position is responsible for the oversight of the department performance, staffing, and referral clerks/coordinators supervision.

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

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, sit, talk or hear. The employee is occasionally required to use hands to handle, or feel objects, keyboard or controls; and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.