Payor Authorization Operations Manager

Abby Care•Denver, CO

2d•Remote

About The Position

Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving. Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home. Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide. We are rapidly expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We’re supported by top, mission-driven VCs to empower families throughout the country.

Requirements

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.
Bachelor's degree in Healthcare Administration, Business, or equivalent is preferred.
Colorado Medicaid certification and LTHH authorization training strongly preferred.
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.

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.