Referral Authorization Manager

T.h.e.-Health-; Los Angeles (CA); On-site; USD 75,000 - 105,000; Full time

Job summary

T.h.e.-Health- in Los Angeles, CA seeks an experienced supervisor to oversee the referral and pre-authorization workflow within the Patient Services department.

You will manage staff, train and evaluate team members, align scheduling, and ensure timely processing while maintaining compliance with insurer requirements.

The role requires bilingual Spanish, strong medical terminology knowledge, and experience with ECW and E-Consult in fast-paced clinical settings.

Qualifications

• 4 years of progressive experience processing referrals and pre-authorizations.
• 1-2 years of experience supervising direct reports.
• Bilingual in Spanish is required.
• Advance knowledge of medical terminology, IPA processes, and ICD/CPT codes.
• Experience in healthcare settings; FQHC experience preferred.
• Experience with regulatory submission timelines.

Responsibilities

• Oversee department performance, staffing, and supervision of referral clerks/coordinators.
• Train, evaluate and manage direct reports; approve schedules and attendance.
• Streamline referral processes and standard operating procedures across clinics.
• Monitor daily referral turnaround times and conversion rates; identify obstacles and provide resolutions.
• Ensure medical documentation meets insurer billing standards.
• Maintain regulatory compliance with required submission timelines.
• Communicate with providers and support staff.

Skills

Bilingual in Spanish

Communication skills

Leadership

Education

High school diploma or equivalent

Tools

ECW (eClinicalWorks)

E-Consult

ICD/CPT coding knowledge

Job description

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 reportsManage staff schedules and approve time and attendanceProvide necessary and routine reportsStreamline 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 accuratelyCommunicate with providers, clinical, and non-clinical support staffEnsure medical documentation meets the billing and approval standards of insurance carriers.Ensure regulatory compliance with required submission timelinesProficient written and verbal communicationAdhere to company policy and procedures4 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 codesExperience working in a professional setting, healthcare related and/or supervisory experience, FQHC experience preferredExperience with ECW and E-ConsultHighschool graduate or higher educationAbility to work with population or diverse cultural, educational, social, and economic backgrounds