Director of Authorizations and Eligibility

Director of Authorizations and Eligibility Location: Remote Department: Revenue Cycle Management Reports To: Senior Vice President, Revenue Cycle Management About Already Autism Health Already Autism Health is a leading provider of autism care services dedicated to improving the lives of children and families through high-quality Applied Behavior Analysis (ABA) therapy and comprehensive diagnostic evaluations.

Operating across multiple states, we are committed to expanding access to care, delivering exceptional clinical outcomes, and creating a best-in-class experience for our patients, families, providers, and team members.

Position Summary

The Authorizations Director is responsible for the strategic oversight, operational management, and performance optimization of all payer authorization activities across the organization. This role ensures timely acquisition, renewal, modification, and maintenance of insurance authorizations for Applied Behavior Analysis (ABA) services while maximizing reimbursement, minimizing authorization-related denials, and supporting seamless client access to care.

The Authorizations Director will collaborate closely with Clinical Operations, Intake, Scheduling, Billing, Credentialing, and Revenue Cycle teams to ensure authorizations accurately reflect authorized services, payer requirements, medical necessity standards, and organizational goals. This leader will establish scalable processes, drive key performance indicators, ensure regulatory compliance, and lead continuous improvement initiatives related to payer authorization management.

Essential Duties

& Responsibilities Leadership & Team Management Lead and develop the Authorizations Department responsible for initial authorizations, reauthorizations, concurrent reviews, appeals, and authorization maintenance. Establish departmental goals, productivity standards, and performance metrics. Recruit, train, coach, and evaluate authorization team members.

Build a culture focused on accuracy, accountability, customer service, and continuous improvement. Create staffing models and workflows that support organizational growth. Authorization Operations Oversee submission, tracking, approval, and renewal of authorizations across commercial, Medicaid, and managed care payers.

Ensure timely processing of initial authorizations and reauthorizations to prevent service interruptions. Monitor authorization utilization and proactively address expiring or exhausted authorizations. Develop escalation processes for urgent authorization needs. Maintain payer-specific authorization requirements, documentation standards, and submission procedures.

Oversee authorization corrections, modifications, extensions, and retroactive requests when applicable. Revenue Cycle Collaboration Partner with other RCM teams to reduce authorization-related denials and write-offs. Analyze denial trends and implement corrective action plans. Establish controls to ensure billing occurs only against valid authorizations.

Collaborate with Scheduling teams to align client schedules with authorized service levels. Work with Clinical teams to ensure timely submission of treatment plans and supporting documentation required for payer approval. Payer Relations & Compliance Serve as the organizational subject matter expert on authorization requirements for services.

Develop and maintain strong working relationships with payer representatives. Monitor payer policy changes and communicate operational impacts to stakeholders. Ensure compliance with federal, state, Medicaid, and commercial payer requirements. Maintain department readiness for internal and external audits. Performance Analytics & Reporting Develop and monitor key performance indicators (KPIs) including: Authorization approval rates Initial authorization turnaround time Reauthorization turnaround time Authorization-related denial rates Authorization expiration rates Revenue at risk due to pending authorizations Appeal success rates Provide regular reporting to executive leadership regarding authorization performance and trends.

Utilize data analytics to identify operational opportunities and improve efficiency. Process Improvement & Systems Management Design and implement standardized authorization workflows across the organization. Evaluate and optimize system functionality related to authorization management. Partner with IT and operational teams on automation initiatives.

Create and maintain SOPs, training materials, and departmental policies. Lead cross-functional projects aimed at improving authorization efficiency and reducing administrative burden.

Qualifications

Bachelor’s degree in healthcare administration, Business Administration, Finance, Accounting, or related field required. Master’s degree preferred. Minimum of 7 years of healthcare Central. Reach or revenue cycle experience. 3+ years of leadership experience managing authorization or revenue cycle teams. Experience with ABA, behavioral health, pediatric therapy, or diagnostic services strongly preferred.

Experience leading process improvement and operational transformation initiatives.