Referrals Manager

Gracelight Community Health•Los Angeles, CA

6d•$72,578 - $90,252•Onsite

About The Position

The Referrals Manager leads Gracelight's centralized Referrals and Medical Records departments. The role is accountable for timely completion of specialty referrals and authorizations, accurate and compliant release and retention of medical records, and the productivity, quality, and customer service performance of both departments. The Manager supervises departmental staff, owns the workflows and systems that move referrals and records, and works with providers, health center leadership, managed care, revenue cycle, quality, and IS to close referral loops and reduce delays.

Requirements

Three or more years of experience in referral management, medical records, patient access, or healthcare operations
Two or more years of supervisory experience managing staff performance.
Working knowledge of Medi-Cal and Medicare managed care authorization processes, referral coordination, HIPAA, and California medical records law.
Experience with an electronic health record (OCHIN Epic preferred), referral management systems, managed care portals, and LANES.
Ability to build reports and dashboards and analyze departmental performance data; advanced Excel.
Personal cell phone available for business use; stipend provided per policy.
Employment is conditioned on background check, Title XXII clearance, OIG/SAM screening, and health screening.

Nice To Haves

Bachelor's degree in healthcare administration, health information management, business, public health, or a related field preferred.
RHIT or RHIA certification preferred.
FQHC or community health center experience preferred.
Bilingual English/Spanish strongly preferred.

Responsibilities

Directs day-to-day operations of the Referrals and Medical Records departments, including workflows, policies, procedures, and service standards.
Supervises referral coordinators and medical records staff: hires, trains, schedules, coaches, evaluates, and manages performance; distributes workload to meet turnaround and productivity targets.
Ensures referrals and authorizations are processed accurately and on time in compliance with payer requirements, and that no referral is lost between order and completed specialty visit.
Ensures medical records are released, stored, and retained in accordance with HIPAA, California law, HRSA requirements, and organizational policy, and that records requests meet turnaround standards.
Sets departmental KPIs and monitors performance on referral turnaround, authorization completion, referral aging and closure, records turnaround, productivity, and customer service; identifies gaps and leads corrective action and quality improvement.
Prepares monthly department reports and dashboards for leadership and recommends process changes based on the data.
Manages the department budget and staffing levels; identifies opportunities to reduce delays and improve productivity, including through technology.
Owns the department's use of Epic, referral management tools, managed care portals, and LANES; optimizes configuration, tracking, and reporting with IS.
Maintains working relationships with managed care organizations, specialty providers, hospitals, and imaging centers to improve authorization turnaround and specialty access.
Works with providers, health center leadership, Patient Access, Revenue Cycle, Quality, and Compliance to resolve referral and records issues affecting patient care, and support audits, surveys, and managed care reviews.
Performs all other duties as assigned.