Job Description
Job Description
Now Hiring: Referral Authorizations Manager
Are you a healthcare operations professional with a passion for streamlining processes and leading high-performing teams? We are looking for an experienced Referral Authorizations Manager to lead our authorizations department and oversee the end-to-end process for medical procedure approvals.
This position plays a vital role in supporting efficient patient care by ensuring timely and accurate insurance authorizations, maintaining regulatory compliance, and working closely with our clinical, surgical, and administrative teams.
Key Responsibilities:
Leadership & Department Oversight
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Supervise daily operations of the referral authorizations department.
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Manage, train, and mentor team members to ensure high performance and compliance with payer requirements.
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Monitor staff productivity and deliver regular performance feedback.
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Promote a culture of accountability, accuracy, and exceptional service.
Authorization & Insurance Coordination
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Oversee submission and follow-up of all medical procedure and referral authorizations.
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Ensure timely approvals by verifying clinical documentation, coding, and insurer-specific requirements.
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Collaborate with clinical staff, schedulers, billing teams, and pharmacies to avoid authorization delays or denials.
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Serve as an escalation point for complex or delayed authorization cases.
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Educate staff and providers on changing payer guidelines and prior authorization protocols.
Compliance & Reporting
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Ensure compliance with HIPAA and applicable state/federal regulations.
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Track key performance metrics including approval rates and turnaround times.
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Analyze denial trends and develop process improvements to reduce errors and improve efficiency.
Process Improvement & Technology Integration
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Evaluate and streamline department workflows to support operational goals.
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Recommend and implement technology tools to enhance performance.
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Stay current on industry trends and payer changes impacting authorization procedures.
Qualifications:
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Bachelor’s degree in Healthcare Administration, Business, or a related field (preferred).
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3–5 years of experience in medical authorizations, insurance verification, or related healthcare operations roles.
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Prior experience in a supervisory or management capacity strongly preferred.
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Strong knowledge of insurance processes, medical terminology, CPT/HCPCS coding.
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Proficiency in EMR/EHR systems and prior authorization platforms.
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Excellent leadership, communication, and organizational skills.
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Bilingual English/Spanish preferred.
What We Offer:
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Competitive Salary
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Comprehensive Benefits Package including:
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Health, Dental, and Vision Insurance
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401(k) Retirement Plan
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Supportive and collaborative team environment
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Opportunities for professional growth and leadership development
Work Environment:
This is an office-based position with frequent interaction across departments including scheduling, billing, clinical teams, and revenue cycle. Regular coordination with surgical centers and external providers is also part of this critical role.