Authorization & Referral Manager - Patient Access

The Authorization & Referral Manager is responsible for leading and overseeing all aspects of authorization, precertification, and referral processes within Patient Access. This role ensures timely, accurate, and compliant insurance authorizations and referrals to support optimal patient care and revenue cycle outcomes. This person requires excellent interpersonal skills and the ability to work with minimal supervision.

Work Schedule

Monday - Friday, 8:00 AM – 5:00 PM, or as directed by department director.

Primary Duties

• Manage daily operations of the authorization, precertification and referral teams.
• Ensure all required authorizations are obtained prior to services, in accordance with payer requirements.
• Develop and enforce standardized workflows for insurance verification, authorization, and precertification processes.
• Collaborate with clinical departments, scheduling, and revenue cycle teams to ensure seamless patient access and service delivery.
• Monitor work queues and staffing levels to maintain productivity and service standards.
• Provide leadership, coaching, and development for authorization team members.
• Monitor staff performance and productivity, ensuring adherence to departmental expectations and service level agreements (SLAs).
• Conduct performance evaluations and support employee engagement initiatives.
• Identify training needs and implement ongoing education related to payer requirements and regulatory changes.
• Track, analyze, and report on departmental Key Performance Indicators (KPIs), such as:
  • Authorization and referral turnaround times
  • Approval/denial rates
  • Pre-service authorization and referral compliance rate
  • Productivity metrics (e.g., cases processed per FTE)
• Develop dashboards and reports for leadership to support data-driven decision-making.
• Identify trends, root causes of denials, and opportunities for improvement.
• Present findings and recommendations to the Director of Patient Access and senior leadership.
• Lead continuous improvement initiatives to streamline authorization workflows and reduce delays or denials.
• Ensure compliance with payer policies, regulatory requirements, and organizational standards.
• Partner with Revenue Integrity and Denials Management teams to address authorization-related denials and implement corrective actions.
• Maintain knowledge of evolving industry regulations and payer guidelines.
• Act as a liaison between Patient Access, clinical departments, payers, and external partners.
• Support cross-functional initiatives aimed at improving patient experience and financial outcomes.
• Assist in system enhancements, including EHR and authorization tool optimization.

Qualifications/Specifications

• Education: Bachelor’s degree in Healthcare Administration, Business Administration, or related field preferred
• Licensure/ Certification: none required
• Experience: Minimum 5 years healthcare or revenue cycle experience. Minimum 3 years leadership experience. Strong knowledge of payer requirements, leadership, communication, analytical skills, and ability to manage multiple priorities.