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Manager, Insurance Operations

Remote

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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