Manager, Insurance Operations
At Affect, we’re building a fully virtual addiction and mental health treatment program designed for real life -- and that starts with removing barriers to care.
As the Manager, Insurance Operations at Affect, you are the bridge between clinical care, the member experience, and our Revenue Cycle Management (RCM) teams. Your mission is to eliminate insurance-based friction. You will own the entire "pre-claim" insurance lifecycle: from the moment a potential member’s insurance is triggered for verification to the point their claim is successfully billed. While the RCM team handles the technical submission of claims, you own the data integrity, authorizations, and payer-facing coordination that make those claims successful.
Responsibilities include:
Verification of Benefits (VOB) & Eligibility
Design and manage a seamless VOB workflow to ensure swift and accurate payer coverage before a member’s first session
Own the process to identify members whose insurance has lapsed and manage the outreach process to secure new coverage or payment plans
Own the resolution of Coordination of Benefits (COB) issues, working directly with members and payers to ensure the correct primary/secondary order is established, as well as the vendors utilized to work these issues
Prior Authorization & Utilization Management
Own and optimize workflows to request, track, and renew prior authorizations, leveraging existing tools and identifying opportunities for automation and improvement
Analyze rejection patterns within Candid to identify root causes related to authorizations or member data and implement upstream fixes, as well as working current issues to resolution
RCM Partnership & Denial Resolution
Partner closely with the RCM team, who owns claim submission and collections, while your team owns the accuracy and completeness of all upstream insurance data
Serve as a primary operational point of contact for insurance payers, resolving eligibility, authorization, and member data issues and escalating systemic challenges as needed
Member Financial Experience & Billing
Oversee the member-facing side of the billing process (e.g., invoices, collections of copays/deductibles) to ensure it aligns with Affect’s compassionate mission
Serve as an internal champion for Candid, optimizing the platform’s insurance, prior auth, and member-pay workflows to reduce manual work
Vendor Performance Management
Manage external vendors involved in eligibility checking, specialized insurance discovery, and active member insurance issues (e.g., Coordination of Benefits)
Track and report on VOB turnaround time, authorization success rates, and "front-end" denial rates
Reporting and Analysis
Provide regular reporting on key KPIs, such as time-to-verify insurance for potential members, percentage of COB denials, and more
Conduct in-depth analysis to identify trends, opportunities, and areas for improvement
Requirements:
3-5+ years of experience in healthcare operations, insurance operations, or revenue cycle, with direct experience in eligibility, benefits verification, and prior authorizations
Strong understanding of:
Insurance eligibility and benefits (commercial + Medicaid preferred)
Prior authorization workflows and payer requirements
COB resolution
Experience partnering with RCM and/or billing teams to reduce denials and improve clean claim rates
Experience working with external vendors and managing performance against SLAs
Proven ability to manage and improve operational workflows with strong attention to detail
Ability to demonstrate a commitment to quality and excellence
Exceptional analytical and problem-solving skills
Systems thinker
Committed to a high ethical standard in everything you do
Familiarity with EMRs, Practice Management solutions, Metabase (or other BI tools), Google Suite, and Slack
If you are passionate about making a difference in the lives of individuals with substance use disorders, possess the qualifications outlined above, and want to be part of a forward-thinking organization that values passion, empathy, and accountability, we encourage you to apply for the Manager, Insurance Operations position at Affect. Join our team and contribute to our mission of providing virtual treatment and support to those in need.
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