Precertification & Authorization Manager

Position Summary:

The Precertification & Authorization Manager is responsible for leading the daily operations of the surgical precertification team, including oversight of local staff and offshore vendors. This leader will ensure timely and accurate verification of insurance benefits, prior authorizations, and pre-surgical financial clearance to support over 3,000 monthly surgical cases. A hands-on, solutions-driven leadership style is essential to navigating complex payer requirements, collaborating with physicians, and delivering exceptional patient and provider experiences.

Key Responsibilities:

Lead and manage the Surgical Precertification team, including three on-site Coordinators and two offshore vendor teams Ensure all surgical cases are authorized at least 30 days prior to the scheduled procedure to avoid OR delays Oversee insurance eligibility checks, benefit verifications, prior authorizations, and patient financial pre-collections Serve as the escalation point for complex or high-priority cases, working closely with local staff and vendors to resolve Track productivity, error rates, turnaround times, and ensure accountability across internal and third-party staff Maintain compliance with payer guidelines, surgical site requirements, and tax ID/location protocols Communicate effectively with physicians and surgical teams, balancing urgency and diplomacy Partner with leadership on process improvements, policy updates, and quality assurance initiatives Support training and development of new staff, including cross-training when appropriate Approve time off, ensure adequate coverage, and support staffing flexibility during high-volume periods Monitor KPIs and provide regular reporting to the Director of Patient Services Participate in leadership meetings and strategic planning for

Patient Services Required Qualifications:

Bachelor's Degree preferred; equivalent experience considered 5+ years of progressive experience in revenue cycle, prior authorization, or surgical services Prior leadership or team management experience strongly preferred In-depth understanding of medical insurance benefits, precertification, and surgical scheduling workflows Proficient in systems such as Availity, Evicore, United Healthcare portals, and Athena Strong problem-solving skills with ability to adapt quickly and think outside the box Excellent communication skills and experience working in fast-paced, high-pressure environments

Preferred Attributes:

Experience managing third-party vendors or offshore teams Familiarity with orthopaedic or high-volume surgical practices Professional, solution-focused demeanor with ability to lead by example Willingness to "roll up sleeves" and work alongside staff when needed

About Florida Orthopaedic Institute:

Founded in 1989, Florida Orthopaedic Institute (FOI) is the largest orthopaedic group in Florida and a leader in comprehensive musculoskeletal care. With over 150 physicians and advanced practitioners across 20+ locations, we provide specialized services in orthopaedics, spine, sports medicine, pain management, and more. Our mission is to provide high-quality, compassionate, and affordable care that keeps our patients moving. At FOI, you'll be part of a purpose-driven organization that values innovation, teamwork, and excellence in patient care. Why Join Us? This is a high-impact role for a strong leader who thrives in fast-paced environments, values collaboration, and wants to be part of a team that's transforming the way we deliver surgical care. If you are passionate about operational excellence, solving complex problems, and driving results that directly affect patient outcomes, we encourage you to apply. Precertification & Authorization Manager 3.0 3.0 out of 5 stars 5901 East Fowler Avenue, Temple Terrace, FL 33617 Florida Orthopaedic Institute 112 reviews

Position Summary:

The Precertification & Authorization Manager is responsible for leading the daily operations of the surgical precertification team, including oversight of local staff and offshore vendors. This leader will ensure timely and accurate verification of insurance benefits, prior authorizations, and pre-surgical financial clearance to support over 3,000 monthly surgical cases. A hands-on, solutions-driven leadership style is essential to navigating complex payer requirements, collaborating with physicians, and delivering exceptional patient and provider experiences.

Key Responsibilities:

Lead and manage the Surgical Precertification team, including three on-site Coordinators and two offshore vendor teams Ensure all surgical cases are authorized at least 30 days prior to the scheduled procedure to avoid OR delays Oversee insurance eligibility checks, benefit verifications, prior authorizations, and patient financial pre-collections Serve as the escalation point for complex or high-priority cases, working closely with local staff and vendors to resolve Track productivity, error rates, turnaround times, and ensure accountability across internal and third-party staff Maintain compliance with payer guidelines, surgical site requirements, and tax ID/location protocols Communicate effectively with physicians and surgical teams, balancing urgency and diplomacy Partner with leadership on process improvements, policy updates, and quality assurance initiatives Support training and development of new staff, including cross-training when appropriate Approve time off, ensure adequate coverage, and support staffing flexibility during high-volume periods Monitor KPIs and provide regular reporting to the Director of Patient Services Participate in leadership meetings and strategic planning for

Patient Services Required Qualifications:

Bachelor's Degree preferred; equivalent experience considered 5+ years of progressive experience in revenue cycle, prior authorization, or surgical services Prior leadership or team management experience strongly preferred In-depth understanding of medical insurance benefits, precertification, and surgical scheduling workflows Proficient in systems such as Availity, Evicore, United Healthcare portals, and Athena Strong problem-solving skills with ability to adapt quickly and think outside the box Excellent communication skills and experience working in fast-paced, high-pressure environments

Preferred Attributes:

Experience managing third-party vendors or offshore teams Familiarity with orthopaedic or high-volume surgical practices Professional, solution-focused demeanor with ability to lead by example Willingness to "roll up sleeves" and work alongside staff when needed

About Florida Orthopaedic Institute:

Founded in 1989, Florida Orthopaedic Institute (FOI) is the largest orthopaedic group in Florida and a leader in comprehensive musculoskeletal care. With over 150 physicians and advanced practitioners across 20+ locations, we provide specialized services in orthopaedics, spine, sports medicine, pain management, and more. Our mission is to provide high-quality, compassionate, and affordable care that keeps our patients moving. At FOI, you'll be part of a purpose-driven organization that values innovation, teamwork, and excellence in patient care. Why Join Us? This is a high-impact role for a strong leader who thrives in fast-paced environments, values collaboration, and wants to be part of a team that's transforming the way we deliver surgical care. If you are passionate about operational excellence, solving complex problems, and driving results that directly affect patient outcomes, we encourage you to apply.