Abby Care · 2 months ago
Payor Authorization Operations Manager
Indianapolis
Full-time
Hybrid
Senior Level
5+ years expAbby Care is a company focused on transforming family caregiving by employing and training family caregivers. The Payer Authorization Operations Manager will be responsible for overseeing prior authorization operations for home health services in Indiana, ensuring compliance and seamless patient care across various insurance programs.
Child CareHealth CareHome Health Care
Responsibilities
Master Indiana’s Prior Authorization landscape. Lead prior authorization operations for Indiana’s home health services through fee-for-service, Managed Care Entities, and commercial insurance, as well as IHCP waiver programs (ATTC, SFC, HCA), ensuring 100% compliance with IHCP policies and system requirements
Oversee end-to-end prior authorization. Own prior authorization process while leading and managing the team of Doc Collectors and Re-Authorization Associates, maintaining current knowledge of payer requirements and ensuring adherence to all guidelines and timelines
Manage Reauthorizations. Build out the process and manage the team handling all reauthorization submissions for Indiana’s programs and services to ensure patients have no lapse in care
Internal Coordination. In cases where appeals and administrative reviews are needed, act as an expert to help families navigate the process as and when appropriate. Coordinate with our internal teams to troubleshoot and resolve any issues around authorizations impacting the revenue lifecycle
Lead complex case resolution. Serve as the escalation point for disputed Indiana Medicaid authorizations, appeals, and emergency requests, working directly with IHCP, MCOs, and Commercial Payers to advocate for timely patient care approvals
Navigate dual eligibility complexities. Build expertise in Medicaid coordination for Indiana beneficiaries; manage intricate authorization scenarios involving and ensure seamless care transitions
Drive team excellence. Create and execute training programs on Indiana-specific prior authorization requirements, mentor staff on waiver nuances, and establish performance metrics that drive strong approval rates and sub-10-day processing times
Qualification
Required
5+ years of experience with Indiana Medicaid authorization (FFS, MCO, and waiver programs) with a proven track record of managing complex authorization portfolios and achieving high approval rates
Existing deep knowledge of Indiana's PA ecosystem including IHCP policies, prior auth operations, case coordination, and MCO systems; can demonstrate successful navigation of Indiana waiver program transitions and appeals
Expert relationship builder with strong communication, problem-solving, and stakeholder management skills; proven ability to work effectively with state agencies, payer entities, and provider networks
High-agency operator who executes cross-functional work in ambiguous regulatory environments; process-driven and metrics-focused with experience in CRM systems, data analysis, and Indiana-specific compliance requirements
Preferred
Bachelor's degree in Healthcare Administration, Business, or equivalent is preferred
Benefits
Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus.
Comprehensive health coverage that works for you. We cover 90% of your premiums and 70% for your dependents, with multiple PPO plan options to choose from for medical, vision, dental, life, and short-term disability.
Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays.
Team bonding. We love bringing our teams together. As a full-time employee, you’ll get to connect, collaborate, and have fun through team activities and our annual company retreat.
Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered).
Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows.
Company
Abby Care
Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase