Director of Insurance Operations
On-siteNewark, New Jersey, United States
Job Summary
Lead and oversee the authorization department, ensuring requests, renewals, and follow-ups are completed accurately within required timelines. Drive resolution for authorization delays, denials, and payer issues while managing provider and organizational credentialing with commercial insurers and Medicaid plans. Improve workflows, tracking, and accountability for credentialing, contracting, network participation, and eligibility verification processes. Develop scalable systems to monitor departmental KPIs, aging reports, and outstanding items. Handle complex payer escalations and build relationships with insurance companies, personally stepping in to resolve difficult cases as needed. Work closely with clinical, intake, billing, and executive leadership to ensure accurate benefit communication and continuous process improvement across multiple states.
Required Qualifications
- 5+ years of ABA insurance or payer operations experience
- Significant hands on experience with ABA authorizations
- Insurance contracting experience
- Provider and organizational credentialing experience
- Strong experience with commercial insurance plans and Medicaid managed care organizations
- Strong understanding of ABA CPT codes, authorization requirements, and payer processes
- Experience with eligibility and benefits verification
- Prior experience managing authorization, credentialing, or insurance operations teams
- Strong systems and workflow management skills
- Experience using systems to manage workflows, tracking, accountability, and departmental operations
- Strong experience working within an EHR or practice management system and the ability to learn and optimize new systems
- Comfortable working with payer portals, CAQH, Medicaid enrollment systems, reporting tools, and spreadsheets
- Ability to work effectively in a fast paced, high volume environment
- Highly organized with strong follow through and attention to detail
- Strong communication, leadership, and problem solving skills
- Ability to identify inefficient processes and implement stronger systems
- Ability to take ownership of complex issues and drive them through resolution
Desired Qualifications
- Experience working within a multi-state ABA or behavioral healthcare organization
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