Referral Authorization Manager

The Health And Wellness Centers; Los Angeles (CA); On-site; USD 70,000 - 75,000; Full time

Job summary

The Health And Wellness Centers in Los Angeles is seeking an experienced Referral Operations Supervisor to oversee referral and pre-authorization processes across clinics. You will manage staff, streamline workflows, and ensure timely, accurate documentation for billing purposes.

Ideal candidates bring 4+ years in medical referrals, 1–2 years of leadership, and fluent Spanish. Knowledge of EPIC equivalents like ECW and E-Consult is preferred; FQHC experience is a plus.

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).
• Advanced knowledge with medical terminology, IPA processes, and ICD, CPT codes.
• Experience with ECW and E-Consult.
• High school graduate or higher education.

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 across clinics.
• Monitor daily referral and pre-authorization turnaround time and conversion rates; identify obstacles and provide resolutions.
• Review and analyze all referrals/authorizations submitted by the health centers timely and accurately.
• Communicate with providers and staff.
• Ensure medical documentation meets billing and approval standards of insurers.
• Ensure regulatory compliance with submission timelines.
• Proficient written and verbal communication.
• Adhere to company policies and procedures.

Skills

Bilingual Spanish

Staff management

Process optimization

Communication

Education

High school diploma or equivalent

Tools

ECW

E-Consult

Job description

Job Details

Job Location: La Brea - Los Angeles, CA 90016

Salary Range: $70,304.00 - $75,000.00 Salary/year

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.
• 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