Abby Care
Operations
PayerAuthorizationOperationsManager
Neural analysis suggests this role is
optimal for Mid candidates.
“Payer Authorization Operations Manager at Abby Care. Skills: process management, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement, Colorado Medicaid authorization experience, LTHH ecosystem knowledge, relationship building, stakeholder management. 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 10”
What You'll Achieve.
ensuring 100% compliance with HCPF policies and ColoradoPAR system requirements; maintaining current knowledge of payer requirements and ensuring adherence to all guidelines and timelines; ensure patients have no lapse in care; resolve any issues around authorizations impacting the revenue lifecycle; advocate for timely patient care approvals; ensure seamless care transitions; drive approval rates and sub-10-day processing times
Industry & Context.
problem-solving
What They're Looking For.
Must Have
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 can demonstrate successful navigation of Colorado waiver program transitions and appeals., Expert relationship builder with communication, problem-solving, and stakeholder management proven ability to work effectively with state agencies, payer entities, and provider networks., High-agency operator who executes cross-functional work in ambiguous regulatory process-driven and metrics-focused with experience in CRM systems, data analysis, and Indiana-specific compliance requirements.
Nice to Have
Bachelor's degree in Healthcare Administration, Business, or equivalent is preferred., Colorado Medicaid certification and LTHH authorization training strongly preferred.
What You'll Do.
Master Colorado's LTHH landscape.
Lead authorization operations for Colorado's HCBS waiver programs (CHCBS
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.
Build out the process and manage the team handling all reauthorization submissions for Colorado's waiver programs (CHCBS
CFC) and Long Term Home Health services to ensure patients have no lapse in care.
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.
Serve as the escalation point for disputed Colorado Medicaid authorizations
and emergency requests
working directly with HCPF and Acentra (Kepro) to advocate for timely patient care approvals.
Build expertise in Medicaid coordination for Colorado manage intricate authorization scenarios involving and ensure seamless care transitions.
Create and execute training programs on Colorado-specific prior authorization requirements
mentor staff on LTHH waiver nuances
and establish performance metrics that drive approval rates and sub-10-day processing times.
How You'll Work.
Team & Collaboration
cross-functional coordination; work effectively with state agencies, payer entities, and provider networks; Coordinate with our internal teams to troubleshoot and resolve any issues around authorizations impacting the revenue lifecycle; working directly with HCPF and Acentra (Kepro); mentor staff
Communication Scope
Expert relationship builder with communication, problem-solving, and stakeholder management proven ability to work effectively with state agencies, payer entities, and provider networks.
Full Job Description
About 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. 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. THE ROLE We're looking for a passionate and detail-oriented expert to join us as a Payer Authorization Operations Manager. This is a Full-Time Remote opportunity based in Denver, Colorado. You are a strategic authorization operator who turns complex Colorado LTSS and LTHH requirements into seamless patient care—navigating Colorado Medicaid systems and building trust with case managers, internal stakeholders, and HCPF to ensure uninterrupted services for vulnerable populations. KEY 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 progra
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