Payor Authorization Operations Manager

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. Reporting to the Care Operations Manager, you will take ownership of our operational pipeline, collaborate cross-functionally to optimize the revenue lifecycle, and serve as the ultimate champion for our families navigating complex state systems. A strategic authorization operator, you turn complex Massachusetts LTSS and LTHH requirements into seamless patient care. You are equally comfortable navigating regional Medicaid systems and building deep trust with case managers, internal stakeholders, and state agencies to advocate for vulnerable populations. High-agency and process-driven, you have a passion for mentoring staff, analyzing operational metrics, and executing cross-functional work within ambiguous regulatory environments. This is a Full-Time hybrid opportunity based in Braintree, MA (Boston).

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.
• What success looks like:
• What you'll have:
• Required Qualifications:
• 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 coordinati

Benefits

Additional Information

About Abby Care: Powering the future of care at home for all of America. 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.

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