Authorization & Credentialing Manager

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 310 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 Drivers 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.

Created: 2026-03-10