Abby Care

Payor Authorization Operations Manager

Boston · Contract

Sponsorship not specifiedDetected 27 days ago

Data AnalysisStakeholder ManagementCRMPatient CareCommunicationProblem SolvingMentoring

About the role

We're looking for a passionate and detail-oriented leader to join us as a Payor Authorization Operations Manager.
In this role, you will oversee our end-to-end prior authorization and reauthorization processes, managing a dedicated team to ensure 100% compliance and zero lapses in patient care.

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.
Build expertise in Medicaid coordination for beneficiaries and manage intricate authorization scenarios to ensure seamless care transitions.
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.
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.
Navigate dual eligibility complexities: Build expertise in Medicaid coordination for beneficiaries and manage intricate authorization scenarios to ensure seamless care transitions.
We go above and beyond for every family, building strong, lasting relationships.
We continually ask ourselves, "Would we want this for our own families?"
We match their urgency with our own, delivering exceptional care without compromise.
We solve challenges with creativity to deliver results without unnecessary complexity.

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.
High-agency operations background with experience using CRM systems, data analysis, and driving metrics-focused compliance requirements.
High-agency and process-driven, you have a passion for mentoring staff, analyzing operational metrics, and executing cross-functional work within ambiguous regulatory environments.
Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation.
Expert relationship-building skills with strong communication, problem-solving, and stakeholder management capabilities across state agencies, payer entities, and provider networks.
Must reside or be willing to permanently relocate to the Braintree, MA (Boston) area.

Massachusetts Medicaid certification and LTHH authorization training strongly preferred.

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.
Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance.
Generous paid time off.
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.
Redefining healthcare starts with how we treat the parents and children we serve.

equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws.
We are an equal opportunity employer and welcome applicants from all backgrounds, consistent with applicable laws.

This listing is sourced directly from Abby Care's careers page and normalized into a canonical job model.