Insurance Manager

Position Summary

The Insurance Manager serves as the senior leader of the Insurance Department, providing strategic and operational oversight of two core teams: Billing and Insurance Authorization & Credentialing. This individual is responsible for maximizing revenue integrity, ensuring timely reimbursement, reducing claim denials, and maintaining compliance with all payer, state, and federal requirements all within the specialized context of Applied Behavior Analysis (ABA) services. The Manager partners closely with clinical, administrative, and executive leadership to align insurance operations with organizational growth, support multi-payer contracting, and build scalable processes that serve clients and providers effectively.

Department Leadership & Team Management

• Provide direct supervision, coaching, and performance management for the Billing and Authorization team leads and their respective staff.
• Recruit, hire, onboard, and retain high-performing insurance department employees.
• Establish clear KPIs and productivity standards for both teams; conduct regular performance reviews.
• Foster a culture of accountability, accuracy, and continuous improvement across the department.

Insurance Authorization & Verification

• Oversee the end-to-end prior authorization process for all ABA services across commercial, Medicaid, and managed care payers.
• Ensure timely submission and tracking of initial assessments, treatment authorizations, and re-authorization requests.
• Develop and maintain payer-specific authorization workflows and documentation standards.
• Stay current with payer policy changes affecting ABA authorization requirements and communicate updates to clinical and operations teams.
• Serve as the final escalation point for complex payer disputes and authorization denials.

Billing, Claims & Revenue Cycle

• Direct all aspects of the billing cycle: claims submission, payment posting, denial management, accounts receivable follow-up, and collections.
• Avoid billing errors, underpayments, and denials with urgency; implement root-cause corrections.
• Maintain days-in-AR at or below industry benchmarks.
• Serve as the final escalation point for complex payer disputes, claim rejections, and reimbursement issues.

Credentialing, Compliance & Payer Relations

• Ensure full compliance with HIPAA, federal billing regulations, and applicable state insurance laws.
• Serve as the primary point of contact for payer escalations, audits, and contract negotiations.
• Monitor and respond to changes in reimbursement rates, billing mandates, and payer guidelines.
• Oversee all provider credentialing and payer enrollment activities.
• Ensure systems and processes are in place to maintain timely credentialing, recredentialing, and enrollment across all markets.

Reporting, Revenue Integrity & Strategic Planning

• Oversee and monitor the full revenue lifecycle from authorization through claim payment, identifying trends, risks, and opportunities for improvement.
• Develop and maintain departmental KPIs, including authorization approval rates, clean claim rates, denial rates, collections, days in AR, and overall revenue cycle performance.
• Identify sources of revenue leakage, including authorization lapses, credentialing delays, documentation deficiencies, billing errors, and operational inefficiencies; implement corrective action plans to improve financial outcomes.
• Develop and deliver regular performance reports and actionable insights to executive leadership, supporting strategic decision-making and organizational growth.
• Partner with clinical, operations, and finance leaders to maximize authorized service utilization, improve reimbursement outcomes, and support revenue forecasting and budgeting.
• Lead revenue cycle process improvement initiatives, including optimization of EHR, practice management, billing, authorization, and reporting systems.
• Collaborate, cross-functionally, to support new service offerings, payer expansions, acquisitions, and other organizational growth initiatives.

Vendor Management & Oversight

• Manage the relationship with all third-party billing vendors and revenue cycle partners.
• Establish service-level expectations and performance metrics for outsourced billing functions.
• Monitor vendor performance related to claim submission, denial follow-up, payment posting, and collections.
• Conduct regular audits to ensure vendor accuracy, efficiency, and compliance.
• Identify opportunities to improve workflows between internal teams and external billing partners.