Scale-Up Healthcare Ops Lead: Patient Access & Authorization

PM Consulting; Quezon City; On-site; PHP 1,200,000 - 1,800,000; Full time

Job summary

PM Consulting seeks a Healthcare Operations Manager – Patient Access & Authorization to lead high-volume authorization workflows, ensure compliance, and partner with physicians and payers. This senior role drives performance, transition, and scalable processes in a fast-paced healthcare setting.

You will oversee pre-certification, insurance verification, benefits coordination, and payer communications, ensuring timely, accurate authorizations and patient-centered service.

Qualifications

• Bachelor’s degree in Healthcare Management, Business Administration, Nursing, Allied Health, or a related field required; advanced degree preferred.
• Minimum 5–7 years of experience in healthcare operations, patient access, prior authorization, pre-certification, insurance verification, revenue cycle, or related healthcare environment.
• Minimum 3 years in people management or operational leadership, ideally supervising multiple teams.

Responsibilities

• Provide operational leadership for Patient Access and Benefits & Authorization functions with high-volume workflows.
• Develop and mentor Supervisors, Team Leads, and teams with clear performance expectations.
• Oversee authorization and pre-certification for orthopedic services and related procedures.
• Establish and monitor KPIs: productivity, turnaround time, quality, service levels, and denial rates.
• Analyze data to identify trends, capacity gaps, risks, and improvement opportunities.
• Lead action plans to improve efficiency, quality, and patient access outcomes.
• Escalate complex authorization issues and payer disputes as needed.
• Ensure compliance with CPT, ICD-10, medical terminology, and documentation standards.
• Collaborate with physicians, scheduling, revenue cycle, payers, and leadership to minimize delays.
• Create and maintain standardized workflows, SOPs, and training materials.
• Document authorization activities and payer communications accurately in systems.
• Lead quality assurance and audit programs to ensure regulatory compliance.
• Drive continuous improvement and streamlined workflows across programs.

Skills

Healthcare Operations Leadership

Patient Access & Authorization Mgmt

People & Leadership Development

Performance & Productivity Management

Quality Assurance & Compliance

Data Analysis & Reporting

Stakeholder Management

Strategic Planning

Project Management

Continuous Improvement

Education

Bachelor’s degree in Healthcare Management or related field

Advanced degree preferred

Tools

EHR systems

Payer portals

Microsoft Office

Job description

PM Consulting seeks a Healthcare Operations Manager – Patient Access & Authorization to lead high-volume authorization workflows, ensure compliance, and partner with physicians and payers. This senior role drives performance, transition, and scalable processes in a fast-paced healthcare setting.

You will oversee pre-certification, insurance verification, benefits coordination, and payer communications, ensuring timely, accurate authorizations and patient-centered service.