Job Description

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JOB TITLE: Surgical Authorization Manager

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SUMMARY:

The Surgical Authorization Manager at Progressive Spine & Orthopaedics is responsible for overseeing the entire surgical authorization process, ensuring that all required approvals for surgical procedures are obtained accurately and efficiently. This leadership role manages the Surgical Authorization Team, while working closely with the Surgical Coordinating Team to maintain seamless scheduling and prevent surgical delays.



The Manager provides hands-on oversight of complex cases involving Motor Vehicle Accidents (MVA), Workers' Compensation (WC), and Personal Injury Protection (PIP), ensuring compliance with payer-specific, legal, and state regulatory requirements. The Surgical Authorization Manager combines strong operational leadership with in- depth insurance knowledge to ensure timely approvals and effective team performance.


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DUTIES AND RESPONSIBILITIES:

Oversee and manage the daily operations of the Surgical Authorization Department, including all Coordinators and Specialists, ensuring consistent processes and adherence to departmental standards. Develop, implement, and refine workflows for obtaining and tracking surgical authorizations across commercial, WC, MVA, and PIP payers. Provide guidance and support on complex or escalated authorization cases, including disputed claims, multicarrier scenarios, and denials requiring appeal. Ensure all surgical authorizations are obtained timely to meet surgical scheduling deadlines and prevent cancellations or rescheduling. Monitor department workload, assign cases appropriately, and ensure optimal resource utilization. Conduct regular audits of authorization documentation and EMR records to ensure accuracy, completeness, and compliance with internal and external requirements. Coordinate closely with the Surgical Coordinating Team to maintain realtime communication on authorization status, surgery readiness, and any anticipated delays. Train, mentor, and evaluate staff performance; identify development needs and provide ongoing education in payer requirements, state laws, and process updates. Establish and track departmental performance metrics (e.g., authorization turnaround times, approval rates, denial resolution). Act as the primary liaison with insurance carriers, attorneys, and external stakeholders for highlevel or disputed authorization matters. Prepare and submit appeals for denied authorizations; coordinate physician peertopeer reviews when necessary. Collaborate with leadership to ensure compliance with evolving WC, PIP, and insurance regulations. Participate in crossdepartmental meetings to support continuous improvement in surgical workflow and patient experience. Perform other related duties as assigned by senior management.
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QUALIFICATIONS:

High school diploma or equivalent required; associate or bachelor's degree in healthcare administration or related field preferred. Minimum of 5 years' experience in medical or surgical authorization, with at least 2 years in a supervisory or lead role. Extensive knowledge of WC, MVA, and PIP authorization processes and related state regulations. Strong understanding of outofnetwork payer requirements and appeals processes. Experience collaborating with attorneys, adjusters, and case managers in complex claims. Knowledge of medical terminology and surgical procedures, preferably orthopaedic. Proficiency with EMR systems, insurance portals, and Microsoft Office applications. Exceptional leadership, communication, and organizational skills with the ability manage multiple priorities under tight deadlines. Strong analytical and problemsolving abilities. Knowledge of orthopaedic and spine surgical procedures preferred. Bilingual skills a plus.
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GENERAL EXPECTATIONS:

Ensure confidentiality of patient and practice information in compliance with HIPAA. Lead by example in professional, reliability, and patientcentered service. Maintain strong collaboration between the authorization and surgical coordination teams. Drive accuracy, efficiency, and accountability across all authorization processes. Foster a positive, teamoriented work environment that supports staff growth and

engagement.


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PHYSICAL DEMANDS AND WORK ENVIRONMENT:

This position operates in a professional medical office environment requiring frequent sitting, standing, and computer use. Manual dexterity is needed for documentation and data entry. The role involves multitasking in a fast-paced, high-volume administrative setting.