Abby Care · 2 months ago
Payor Authorization Operations Manager
Denver
Full-time
Onsite
Senior Level
$70K/yr - $77K/yr
5+ years expAbby Care is a company focused on family caregiving, aiming to empower family caregivers through a tech-powered platform. The Payer Authorization Operations Manager will oversee authorization operations for Colorado's Medicaid systems, ensuring compliance and seamless patient care while leading a team and managing complex authorization scenarios.
Child CareHealth CareHome Health Care
Responsibilities
Master Colorado's LTHH landscape. Lead authorization operations for Colorado's HCBS waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services, ensuring 100% compliance with HCPF policies and ColoradoPAR 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 Colorado's waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services to ensure patients have no lapse in care
Internal Coordination. In cases where appeals are needed, act as an expert to help families navigate the appeals 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 Colorado Medicaid authorizations, appeals, and emergency requests, working directly with HCPF and Acentra (Kepro) to advocate for timely patient care approvals
Navigate dual eligibility complexities. Build expertise in Medicaid coordination for Colorado beneficiaries; manage intricate authorization scenarios involving and ensure seamless care transitions
Drive team excellence. Create and execute training programs on Colorado-specific prior authorization requirements, mentor staff on LTHH waiver nuances, and establish performance metrics that drive strong approval rates and sub-10-day processing times
Qualification
Required
5+ years Colorado Medicaid authorization experience (LTHH, LTSS or waiver programs) with a proven track record of managing complex authorization portfolios and achieving high approval rates
Existing deep knowledge of Colorado's LTHH ecosystem including HCPF policies, prior auth operations, case coordination, and ColoradoPAR system; can demonstrate successful navigation of Colorado 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
Colorado Medicaid certification and LTHH authorization training strongly preferred
Benefits
Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work.
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