Job Description

About the Role

We are seeking an experienced Authorization & Credentialing Manager to oversee eligibility, prior authorizations, referrals, and credentialing operations across 8 locations supporting 11 physicians. This leader will manage a high-volume environment while ensuring regulatory compliance, operational efficiency, and strong team performance.

This is an excellent opportunity to join a growing healthcare organization with strong potential for career advancement.

Key Responsibilities

Leadership & Operations

• Oversee daily workflow of the Authorizations and Credentialing Department.
• Manage team productivity and performance across 8 locations.
• Plan, assign, monitor, and evaluate staff performance.
• Prevent backlog by proactively resolving workflow challenges.
• Establish clear departmental objectives and track performance metrics.

Authorizations & Eligibility

• Ensure all patient eligibilities, referrals, and authorizations are obtained prior to appointments.
• Maintain up-to-date knowledge of insurance plans, authorization requirements, and medical necessity guidelines.
• Communicate directly with insurance carriers to stay current on policy updates.
• Maintain timeliness standards and ensure compliance with payer requirements.

Credentialing

• Oversee provider credentialing and recredentialing processes.
• Maintain accurate and confidential credentialing databases.
• Ensure compliance with national accreditation standards and state/federal regulations.
• Verify provider licenses, certifications, and qualifications.

Process Improvement

• Develop and maintain departmental policies and procedures.
• Collaborate with leadership to improve efficiencies and streamline workflows.
• Review and interpret payer contracts.
• Ensure accurate handling of confidential provider information.

Required Qualifications

• 3–10 years of leadership experience in a healthcare setting.
• Strong, in-depth knowledge of insurance authorization processes (“inside and out”).
• Experience managing high-volume, multi-location operations.
• 3+ years of experience reviewing and interpreting payer contracts.
• Working knowledge of credentialing processes.
• Advanced understanding of insurance plans, Medicare, and Medicaid regulations.
• Experience with practice management systems and EHR software.
• Proficiency in Microsoft Office (Word, Outlook, Excel).
• Knowledge of medical terminology.
• Valid California Driver’s License.
• High School Diploma or GED.

Preferred Qualifications

• Medical Assistant Certification.
• 1+ year of demonstrated experience in a similar role.

Soft Skills & Attributes

• Strong attention to detail.
• Ability to manage confidential provider information.
• Excellent interpersonal and customer service skills.
• Strong written and verbal communication skills.
• Ability to adapt and reorganize priorities in a fast-paced environment.

Working Conditions

• Frequently moves items weighing up to 50 lbs.
• Prolonged periods of sitting and computer work.
• Must be able to move throughout office locations as needed.
• Overtime and occasional weekend work as needed.

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