Healthcare Ops Leader - Patient Access & Authorization

Create Synergies Inc.; Philippines; On-site; PHP 1,200,000 - 2,000,000; Full time

Job summary

Create Synergies Inc. is seeking a Healthcare Operations Manager – Patient Access & Authorization to lead end-to-end access workflows, including pre-certification, verification, and approvals.

You will guide supervisors and teams, ensuring compliant, patient-centered processes aligned with client goals. You will drive performance metrics, implement standardized workflows, and partner with clinical teams and payers to minimize delays.

Qualifications

• Bachelor’s degree in Healthcare Management, Business Administration, Nursing, Allied Health, or related field required; advanced degree preferred.
• Minimum 5–7 years of experience in healthcare operations, patient access, prior authorization, pre-certification, or related field.
• Minimum 3 years in people management or operational leadership; experience with supervisors or multiple teams.
• Strong experience in high-volume healthcare operations and performance-driven teams.
• Experience overseeing prior authorization, pre-certification, benefits, eligibility, or patient access functions.
• Orthopedic, hospital, physician practice, or multi-specialty healthcare experience preferred.
• Experience supporting new program implementation, start-up operations, transition, migration, or operational transformation is highly preferred.
• Strong understanding of payer requirements, medical necessity, CPT, ICD-10, and clinical documentation requirements.
• Proficiency with EHR systems, payer portals, authorization platforms, and reporting systems.
• Demonstrated experience using operational data to drive decisions and improvements.
• Knowledge of quality, compliance, and healthcare regulatory requirements.
• Excellent leadership, stakeholder management, and communication skills.

Responsibilities

• Provide operational leadership for Patient Access and Benefits & Authorization functions, ensuring efficient workflows.
• Develop Supervisors and Team Leads with clear performance expectations and accountability.
• Oversee authorization and pre-certification operations for orthopedic services and related procedures.
• Establish and monitor KPIs: productivity, turnaround time, quality, and denial rates.
• Analyze performance data to identify trends, capacity gaps, and risks.
• Lead action plans to improve efficiency, quality, and patient access outcomes.
• Provide escalation support for complex authorization issues and payer disputes.
• Ensure compliance with payer requirements, medical necessity guidelines, CPT/ICD-10, and policy standards.
• Collaborate with physicians, scheduling, revenue cycle, payers to minimize delays and disruptions.
• Develop and maintain standardized workflows, SOPs, and training materials.
• Ensure accurate documentation of authorization activities within EHR and systems.
• Establish governance, communication, escalation, and reporting structures.
• Lead continuous improvement initiatives focusing on process efficiency and cost optimization.
• Manage staffing models and capacity planning based on demand.
• Participate in recruitment, onboarding, and leadership development.
• Provide regular operational reporting to senior leadership.

Skills

Healthcare Operations Leadership

Patient Access Management

Leadership Development

Performance Management

Quality & Compliance

Process Improvement

Workforce Planning

Operational Readiness

Change Management

Data Analysis

Stakeholder Management

Strategic Planning

Project Management

Continuous Improvement

Education

Bachelor’s degree in Healthcare Management, Business Administration, Nursing, Allied Health, or related field

Tools

EHR systems

Payer portals

Authorization platforms

Job description

Create Synergies Inc. is seeking a Healthcare Operations Manager – Patient Access & Authorization to lead end-to-end access workflows, including pre-certification, verification, and approvals.

You will guide supervisors and teams, ensuring compliant, patient-centered processes aligned with client goals. You will drive performance metrics, implement standardized workflows, and partner with clinical teams and payers to minimize delays.