Payor Authorization Operations Manager

Abby Care•Boston, MA

3d•Hybrid

About The Position

Abby Care is building the leading AI-native platform for family-led care. America is facing a growing care crisis. Millions more people need care at home than ever. Over 50 million family caregivers support loved ones without the tools, training, or recognition they deserve. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system. Abby Care combines clinical oversight with an AI-powered platform to train, enable, and support family caregivers in delivering high-quality care at home. Our platform helps health plans and government partners better understand, verify, and improve care in the home. We expand access to care, reduce reliance on higher-cost settings, and help ensure public dollars are spent effectively. We are proud to partner with leading health plans, providers, and community organizations and are backed by top VCs. We envision a future where family-led care is a core part of the healthcare system. Abby Care is building that future. Join us in solving one of the most important challenges of our time.

Requirements

5+ years of Massachusetts Medicaid authorization experience (LTHH, LTSS, or waiver programs) with a proven track record of managing complex authorization portfolios and achieving high approval rates.
Deep existing knowledge of the regional LTHH ecosystem, including HCPF policies, prior authorization operations, case coordination, and MAPAR systems.
Expert relationship-building skills with strong communication, problem-solving, and stakeholder management capabilities across state agencies, payer entities, and provider networks.
High-agency operations background with experience using CRM systems, data analysis, and driving metrics-focused compliance requirements.
Must reside or be willing to permanently relocate to the Braintree, MA (Boston) area.

Nice To Haves

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

Responsibilities

Master the LTHH landscape: Lead authorization operations for Massachusetts HCBS waiver programs (CHCBS, EBD, SLS, CES, CFC) and Long Term Home Health services, ensuring 100% compliance with HCPF policies and PAR system requirements.
Oversee end-to-end prior authorization: Own the prior authorization process while leading and managing a team of Doc Collectors and Re-Authorization Associates, maintaining current knowledge of payer requirements.
Manage reauthorizations: Build out processes and manage the team handling all reauthorization submissions for regional waiver programs and Long Term Home Health services to ensure patients have no lapse in care.
Coordinate internal lifecycles: Partner with internal teams to troubleshoot and resolve authorization issues impacting the revenue lifecycle, and serve as an expert helping families navigate the appeals process.
Lead complex case resolution: Serve as the primary escalation point for disputed 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 beneficiaries and manage intricate authorization scenarios to ensure seamless care transitions.
Drive team excellence: Create and execute training programs on 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.