The Insurance Utilization Manager is responsible for the day to day running of the Authorizations Department. This primarily involves ensuring that accurate authorizations are procured as efficiently as possible, and in accordance with the established timelines. Additionally, the Insurance Utilization Manager considers opportunities for continuous departmental improvement, collaborates with adjacent department leaders to enhance client experience, fosters relationships with payors and other external parties, among other tasks.

The Insurance Utilization Manager works closely with the Director of Patient Access and Intake Manager to provide the highest quality service to potential and existing clients, as well as clinical teammates.

Responsibilities

Manages Authorizations Department staff
Defines and maintains Authorizations Department standard operating procedures
Drives culture of excellence within the Authorizations Department through adherence to company policies and established timelines
Directs daily workload of the Insurance Coordinators according to caseloads and business needs
Responsible for understanding the authorization request processes for each insurance through maintenance of the Authorizations Request Matrix
Provides training and support to Insurance Coordinators
Evaluates Insurance Coordinator performance at regular intervals, offers guidance where needed and implements corrective action when standards are not met
Responsible for administration of Auths Ticketing System
Problem solves authorization and insurance related issues with teammates from other departments (primarily Clinical, Intake, Revenue Cycle and Client Services)
Represents the Authorizations Department at management meetings and leadership events
Represents the Authorization Department in communication with families
Monitors Insurance Coordinator time cards, approves/denies time off requests, in accordance with company and department policies
Collaborates with Director of Revenue Cycle in ongoing procedures (e.g. expired auths reporting, monthly metric analysis, etc.) and unique projects
Identifies departmental weak points and explores opportunities for continuous improvement
Fosters good relations with payors and other external parties to attract referral streams
Any other duties as reasonably expected

Education, Licenses, and Certifications

High School Diploma required; AA/Bachelor’s Degree preferred

Experience

Expertise in insurance authorization process, including initial requests, reauthorizations, and appeals
Familiarity with payer requirements (Medicaid, commercial insurers) and documentation standards.
Understanding of ABA therapy workflows

Autism Learning Partners supports a diverse workforce and is an Equal Opportunity Employer.

At Autism Learning Partners, we understand that culture is the foundation of who we are as a company and how we serve our clients, families, and employees. We are one of the nation's leading full-service ABA providers specializing in the treatment of autism and other developmental disabilities. Our broad thinking approach addresses the whole child by collaborating with doctors, therapists, families, schools, and specialists. Our goal is to work together to achieve the best possible outcome and progress through our commitment to Diversity, Inclusion, and Equity, which includes forming a DEI council, monthly trainings for senior clinical staff, national trainings, a monthly DEI newsletter, continual updates to our email signatures, education on topics like generational trauma and trauma-informed care, and always striving to provide the best care and comfort for our clients, families, and employees.

Job Type: Full-time

Pay: $65,000.00 - $75,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Disability insurance
Employee assistance program
Employee discount
Health insurance
Health savings account
Life insurance
Paid time off
Referral program
Tuition reimbursement
Vision insurance

Schedule:

Monday to Friday

Application Question(s):

To avoid potential conflicts of interest, please answer "Yes" to confirm that you DO NOT have any immediate family members (child, spouse, parent, or sibling) receiving services from Autism Learning Partners, Children's Learning Connection, or A Is For Apple.

Education:

High school or equivalent (Preferred)

Experience:

working with posting payments: 1 year (Preferred)
processing batches: 1 year (Preferred)

Work Location: Remote

Autism Learning Partners jobs

Insurance Utilization Manager